Intelligent Leakage Management Systems

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Electro Scan (UK) Limited

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NEW MEMBER INFORMATION & AGREEMENT FORM

"*" indicates required fields

1. Your organisation

Organisation name*

Organisation address*

Address line 1 Address line 2 Town / City County Post Code Country

Telephone number*

Organisation water related turnover*

2. Membership contact

The person in your organisation who should be receive information about Future Water activities, events & initiatives.

Name*

First Last

Job Title*

Email*

Telephone number*

3. Finance contact

The person in your organisation who should be contacted with regard to financial matters, including annual subscription invoices

Name*

First Last

Job Title*

Email*

Telephone number*

4. Additional organisation contacts

People in your organisation who would like to receive information about Future Water activities, events & initiatives via email. (Please ensure to include the correct email addresses and job titles).

Organisation Contacts

First Name

Last Name

Job Title

5. Your organisation information for the online Future Water members directory.

Organisation website

Organisation summary

Please provide a brief organisation profile - approximately 200 words.

Organisation logo

Please upload a high-res company logo for use on the Networks November webpages, social media and promotional material. Minimum dimensions: 600px X 600px Accepted file types: jpg, png, jpeg Name file: NN21 [organisation name]

Max. file size: 32 MB.

Products & Services

In addition to your organisation description, your member directory entry will also contain details of the services and products you offer. These can be added when you are given your website login details.

Organisation social media

Please share details of your organisation's social media accounts so that Future Water can follow them.

Twitter

Facebook

YouTube

6. Data Protection

Declaration*

We wish to apply for membership of the Future Water

We have read and agree to the Terms & Conditions of membership. We confirm that the information given here is true and accurate and we understand that the submission of misleading information may lead to the refusal of the application or subsequent cancellation of membership.

Please tick the box to confirm that all the information given above is correct.

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