1. SUBSCRIPTION FORM 2010
ORGANISATION
Name :
Mail address : Office address :
Postal code / city : Postal code / city :
VAT-number : Telephone :
IBAN/BIC number :
E-mail address :
Website :
Sector :
Employees : (number)
INVOICING INFORMATION (only fill out when data differs from data above)
E-mail address :
And/or
At the attention of:
Mail address :
Postal code / city :
CONTACT INFORMATION
Ms/Mrs. Mr.
Titel(s) : Initials : Surname :
Department : Function :
Telephone :
E-mail address :
ADDITIONAL REMARKS
1. The settlement day for the organisation size is December 31st of the previous year. A year of
participation stretches from January 1st to December 31st. Participation in Platform ELFA Belgium
during the year is rated at the residual amount of months. Membership will be prolonged
automatically, unless Platform ELFA Belgium office has received a letter of membership
termination before November 1st.
2. Named amounts are excluding VAT and a single time administration fee of € 20,-.
3. The settlement day for the subscription (including whether being appointed as a Founding Partner)
is the day the your payment is received.
4. 50% discount for members of the EEI Platform or Platform ELFA NL.
Platform ELFA Belgium | www.platformelfa.be | info@platformelfa.be 1

2. INVESTMENT FORM 2010
Your investment enables Platform ELFA Belgium to execute activities and instruments, create
opportunities for your organisation and to realise the targets set. For those purposes, the following
investment model for 2010 is implemented:
Organisation type: Size Investment
 Company (solution provider) N.A. € 750,00
 Company (user) N.A. € 250,00
 Company (other) to be discussed
 Government/policy European bodies € 3.000,00
National bodies € 1.500,00
Local and regional bodies € 750,00
 Educational organisation € 500,00
 Sectoral organisation < 250 members € 750,00
250 – 1.000 members € 1.500,00
> 1.000 members € 3.000,00
SUBSCRIPTION
By signing this participation form, your organisation states that:
1. the subscription and investment form has been filled out truthfully;
2. you are an authorized representative of the organisation mentioned above;
3. your organisation agrees with the terms and conditions of Platform ELFA Belgium.
Date : City :
Name : Country : Signature:
Return your subscription before May 1st 2010 and become a Founding Partner!
Platform ELFA Belgium | www.platformelfa.be | info@platformelfa.be 2