Section on Prevention in the Mining Industry - Application for Membership | International Social Security Association (ISSA)

Membership application

International Section of the ISSA on Prevention in the Mining Industry

Name of Member

(Individual / Company / Institution / Association)

Name of Member

Address

Street & Nr

City

City code

Website

Country

Country

General Contact Email

Contact Person 1

Mr / Ms

Title

Family name

First name

Function

E-mail

Phone

Contact Person 2

(optional)

Mr / Ms

Family name

First name

Function

E-mail

Phone

Billing address

(Fill in only if different from Contact Person 1)

Mr / Ms

Family name

First name

Function

E-mail

Phone

Type of membership

Membership category applied for