MEMBERSHIP APPLICATION FORM

Animal Health Division

We hereby apply to be admitted to membership of the Association. We understand that our application must be approved by the members of the Animal Health Division and if admitted to membership, we agree to comply with the Memorandum and Articles of the Association. We also agree to comply with the Bye-Laws of the Division and with the Code of Practice for the Animal Health Industry. We agree to provide an Auditors Certificate on an annual basis confirming our data entries into the Veterinary Market Survey if we participate in this survey.

As part of our membership application, we will forward the relevant subscription sum on request to the Association.

In the event of admission to Membership, the Company will be represented by:

Courtesy title:
Name:
Company:
Address:


Voice phone: ()
Fax: ()
E-mail address: @
Position held in company:
Date of application:
Proposed by* :
Seconded by*: * Proposer and Seconder must be members of the Association.
Registered Office in Ireland:
Name of Directors:
If a subsidiary, state name of parent company and Directors:
If company has subsidiary(s), indicate name(s) and Directors:
State membership of other Trade Organisations:
Number of persons, if any, employed in Ireland:
Does the company manufacture in Ireland?
If so, state type of products:
Is company represented by an Agent in Ireland?
If so, state name and address of Agent:
Does the company act as an Agent?
If so, give name of Principal and details of products handled as agents:

Please post or fax this completed and signed form to: -

Animal and Plant Health Association
31A Ravens Rock Road
Sandyford Industrial Estate
Dublin 18

Phone +353 1 293 0021     Fax +353 1 293 0109