Application for ETSI Membership

Corporate email address to receive acknowledgement of Membership application.

Email address:

Confirmation:

Legally established, registered name and address of the applicant Administration / Organization

Please enter short and long name (even if it is the same)

Short name

Long name:

Phone:

www:

Address:

Address(2):

Address(3):

Address(4):

Postal code:

City:

Country:

Membership status (Full, Associate or Observer Membership)

Legally established in a country within the CEPT* geographical area (Full Membership)

Legally established in a country outside the CEPT* geographical area (Associate Membership)

Eligible for Full or Associate Membership but choosing no participation in technical work (Observer Membership)

* CEPT - European Conference of Postal and Telecommunications Administrations

Active in the following area

Represented by (person who is legally responsible for the company)

Title:

First name:

Last name:

Position:

cognizant of the ETSI Directives available at http://portal.etsi.org/Directives/home.asp hereby applies for ETSI Membership in the category of

Category:	Type field:

and also applies to participate in 3GPP™ (subject to minimum contribution) Yes No

Information related to the Membership fee

Administrations
If another Administration in your country is already an ETSI Member and pays Membership fees according to the Gross Domestic Product (GDP) of your country, please tick this box

If your Administration is responsible for the regulation of electronics communications and related areas in that country, please indicate your country’s GDP in billion €.

Billion €
If none of the above cases apply, but you are a governmental body, please tick this box

Members’ fees are calculated by class based on the declared ECRT (Electronics Communications Related Turnover).

Each class corresponds to a number of units/voting weights. This number determines the contribution payable. SMEs, User/Trade associations, Universities and Public Research Bodies come under class 1.

Organization
Please indicate your organization’s annual ECRT in million €.
In the case where the member's ECRT is not able to be determined from publicly available information, the member will agree with the Director-General on the appropriate Class of Contribution which should apply.

Million € or

Additional Membership
If you are applying for an Additional Membership to an existing Group Membership for which the membership fees have already been determined. Please provide the NAME OF THE ORGANIZATION holding the relevant Group Membership :

Thank you for your organization’s application for ETSI membership.

In order to start the process, please email the printed and signed (scanned) version to membership@etsi.org

For any question, you may contact us at: MED@etsi.org / +33 4 9294 4383.

Membership fee billing address (to be shown on Invoices)
Name:
Address:
Address (2):
Address (3):
Address (4):
Postal code:	City:	Country:

Name and address of Official Contact - the main contact between an ETSI Member Organization and the ETSI Secretariat, to whom all correspondence is sent and who is responsible for the maintenance of that organization’s membership data.
Title:	First name:	Last name:
Phone:	E-mail:
Address:
Address (2):
Address (3):
Address (4):
Postal code:	City:	Country:
Financial Contact is not the same as Official Contact

Name and address of Financial Contact - the person to whom all Membership fee related issues should be sent (if not the same as Official Contact).
Title:	First name:	Last name:
Phone:	E-mail:
Address:
Address (2):
Address (3):
Address (4):
Postal code:	City:	Country:

Name and Title of authorized signatory: