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Membership Application Form / Formulário de solicitação de associação
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FULL OFFICIAL COMPANY NAME IN THE NETHERLANDS: |
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VISITING ADDRESS: |
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POSTAL CODE: |
CITY: |
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COUNTRY: |
WEB-SITE: |
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PHONE: |
FAX: |
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CONTACT PERSON: |
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CONTACT PERSON E-MAIL ADDRESS: |
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GENERAL E-MAIL ADDRESS: |
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BRAZILIAN SUBSIDIARY OR MOTHER COMPANY, IF: |
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FULL OFFICIAL COMPANY NAME: |
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CNPJ TAX NUMBER: |
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STREET ADDRESS WITH NUMBER: |
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POSTAL CODE: |
CITY: |
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COUNTRY: |
WEB-SITE: |
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PHONE: |
FAX: |
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CONTACT PERSON: |
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CONTACT PERSON E-MAIL ADDRESS: |
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GENERAL E-MAIL ADDRESS: |
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MEMBERSHIP FEES TO BE PAID IN ( ) THE NETHERLANDS ( %) |
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( ) BRAZIL ( %) |
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GLOBAL NUMBER OF EMPLOYEES: (UNDER THE SAME COMPANY IDENTIFICATION): |
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MANAGEMENT PRINCIPALS (NAMES, FUNCTIONS AND E-MAIL ADDRESSES): |
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SIGNED BY: |
POSITION: |
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DATE: SIGNATURE:
REMARKS: |
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