LCC Corporate Membership Sign-up: TEMPLATE

Your Organisation

Complete this section with contact details for the organisation which will purchase the corporate membership

Organization Name *

Phone Number

Website

Street Address *

Street Address Line 2

Street Address Line 3

City *

Postal Code *

Country *

Corporate Contact

As the corporate contact at the organisation you will be the person we contact with regard to invoicing and renewing memberships in the future etc. Complete this section with your work email address and phone number.

First Name *

Last Name *

Phone Number *

Email *

Membership

Number of Individual memberships purchased *

How many LCC memberships do you need for your organisation? Please indicate your current requirements - additional memberships can be added later. This number will determine your initial invoice.