APPLICATION FORM FOR TECHNICAL CORRESPONDENT MEMBERSHIP

COMPANY NAME:

ADDRESS:

MAIN ACTIVITY (please tick) Producer Consumer National Association Engineering contractor Equipment supplier Other (please specify):

CONTACT FOR EURO CHLOR:

Name:

Job title:

Telephone:

Fax:

E-mail

Company website:

Company VAT:

Address (only if different from above)

-1- GRADE OF MEMBERSHIP APPLIED FOR (please tick)

Technical Correspondent

ADDITIONAL INFORMATION TO BE GIVEN

 By chlorine producers:

Plant location Country Capacity Type of Cells(1) Year of (in tons) Start-up

1.

2.

3.

4.

(1) membrane, diaphragm, mercury, others

Areas of interest (please tick) Production Storage Transportation Other (please specify):

 By chlorine consumers:

Area of activity:

Annual consumption (please tick) Less than 5000 tons/year From 5000 to 30000 tons/year Above 30000 tons/year

Type of chlorine storage (please tick) Drums/cylinders Iso-containers Rail cars or road tankers Fixed tanks Fixed spheres

-2-  By equipment supplying companies (please complete):

General activities:

Types of equipment supplied to the chlorine industry:

 By others (please complete):

Reasons for wishing to join Euro Chlor:

PLEASE RETURN THE COMPLETED FORM PREFERABLY BY E-MAIL (FAX OR MAIL IS ALSO ACCEPTABLE) TO: Euro Chlor Attn: Chantal Peeters Avenue E Van Nieuwenhuyse 4, Box 2 B-1160 Brussels, Belgium Email: [email protected] Fax: +32 2 676 72 41

-3-