<p> APPLICATION FORM FOR TECHNICAL CORRESPONDENT MEMBERSHIP</p><p>COMPANY NAME:</p><p>ADDRESS:</p><p>MAIN ACTIVITY (please tick) Producer Consumer National Association Engineering contractor Equipment supplier Other (please specify):</p><p>CONTACT FOR EURO CHLOR:</p><p>Name:</p><p>Job title:</p><p>Telephone:</p><p>Fax:</p><p>E-mail</p><p>Company website:</p><p>Company VAT:</p><p>Address (only if different from above)</p><p>-1- GRADE OF MEMBERSHIP APPLIED FOR (please tick)</p><p>Technical Correspondent</p><p>ADDITIONAL INFORMATION TO BE GIVEN</p><p> By chlorine producers:</p><p>Plant location Country Capacity Type of Cells(1) Year of (in tons) Start-up</p><p>1.</p><p>2.</p><p>3.</p><p>4.</p><p>(1) membrane, diaphragm, mercury, others</p><p>Areas of interest (please tick) Production Storage Transportation Other (please specify):</p><p> By chlorine consumers:</p><p>Area of activity:</p><p>Annual consumption (please tick) Less than 5000 tons/year From 5000 to 30000 tons/year Above 30000 tons/year</p><p>Type of chlorine storage (please tick) Drums/cylinders Iso-containers Rail cars or road tankers Fixed tanks Fixed spheres</p><p>-2-  By equipment supplying companies (please complete):</p><p>General activities:</p><p>Types of equipment supplied to the chlorine industry:</p><p> By others (please complete):</p><p>Reasons for wishing to join Euro Chlor:</p><p>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</p><p>-3-</p>