APTLD Membership Application Form
To the Board of APTLD:
Name of Organization:
Address:
Applying for: □ Ordinary Membership □ Associate Membership
The above organization applies for Membership of Asia Pacific Top Level Domain Association (APTLD), in accordance with provisions of the Consultation of APTLD. The applicant agrees to abide by the provisions set forth in the Constitution and by any term and condition determined by the Board and will neither do, nor permit its employees to do, anything which may bring the Association into disrepute.
Representative
Name:
Organization Name:
(if different from applicant)
Address:
E-mail:Phone:Fax:






The Application is Authorized by
Name:
Organization Name:
Title:



Billing Contact
Name:
Organization Name:
(if different from applicant)
Address:
E-mail:Phone:Fax:






Signature of the Authorizer:
The authorized applicant has full authority to apply for membership in APTLD on behalf of the relevant organization.
Date:_____________________
Please submit this form to APTLD General Manager by email at: l.todorov@aptld.org
Revised 30.06.2016