To join online, please complete the form below.

or download the membership form

 

Membership Form

Organization

Name of organization*

Address*

Postal code and city*

Landline phone*

Fax

French NAF code

Billing address (if different)

Legal structure

Number of employees

Sales (previous year)

Website

14-digit SIRET number*

Legal representative

Name of legal representative (last, first)

Title*

Landline phone*

Email*

Mobile phone*

Administrative

Administrative contact person*

Name of administrative contact person*

Landline phone*

Email*

Mobile phone*

Communications/Events/Marketing

Communications/Events/Marketing contact person*

Contact name*

Landline phone*

Email*

Mobile phone*

Your organization’s activities

Do you wish to appear in the Proxinnov website directory?*
yesno

Membership option
Proxinnov as a UserProxinnov as a User and Service Provider

I certify that the information provided above is accurate, and that I have reviewed the internal rules and regulations and the bylaws.
The Bylaws and Code of Conduct are available by writing to: contact@proxinnov.com

Additional message

*Required fields

 

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