Organisation Name *

First Name

Last Name

Membership category and annual fee: *

Organizations with mainly individual members [If your association lacks the financial resources to pay this invoice, you may qualify for the Global Alliance Member Assistance Program. Please contact the GA Center, in confidence, at elena.bernasconi@globalalliancepr.org]

1-300 Individual Members - CHF 350.00

301-1000 Individual Members - CHF 650.00

1001-2000 Individual Members - CHF 950.00

2001-3000 Individual Members - CHF 1550.00

3001-10000 Individual Members - CHF 1950.00

10001+ Individual Members - CHF 2500.00

Membership category and annual fee: *

Organizations with mainly corporate or institutional members [If your association lacks the financial resources to pay this invoice, you may qualify for the Global Alliance Member Assistance Program. Please contact the GA Center, in confidence, at elena.bernasconi@globalalliancepr.org]

Academic Institution - CHF 350.00

Association of Academic Institutions - CHF 650.00

Organization with corporate members - CHF 950.00

Member’s Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Member’s Social Media (complete as appropriate)

Twitter

Facebook

LinkedIn

Blog

Name - A

First Name

Last Name

Phone - A

(###)

###

####

Name - B

First Name

Last Name

Phone - B

(###)

###

####

Code of Ethics and By-laws Agreement *

I certify that our organisation endorses the Global Alliance Code of Ethics and accepts the Global Alliance By-laws.