Name * Type of membership (choose in the following list) * Partner Corporate (>200 employees) SME (<200 employees) Organisation (NGO, NPO) Individual Young Professional (<30 years old) Specify your Sector Activity * Please insert your Company's activity. Number of employees worldwide * Number of employees in Myanmar * Incorporated/Registered in Myanmar - None -YesNo Country of registration of main office or headquarter: Date of registration: Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year2014201520162017201820192020202120222023202420252026 Nationality (as will appear in the Members Directory) —Select a country—AfghanistanAland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBritish Virgin IslandsBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCaribbean NetherlandsCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongo (Brazzaville)Congo (Kinshasa)Cook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHondurasHong Kong S.A.R., ChinaHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyIvory CoastJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacao S.A.R., ChinaMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern Mariana IslandsNorth KoreaNorwayOmanPakistanPalauPalestinian TerritoryPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarReunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluU.S. Virgin IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUnited States Minor Outlying IslandsUruguayUzbekistanVanuatuVaticanVenezuelaVietnamWallis and FutunaWestern SaharaYemenZambiaZimbabwe Address * Phone number Fax number Email Address * Website * Linkedin page (if any): Facebook page (if any): Other links (please specify) General Management (compulsory) Title (Mr., Mrs., Ms.) * - Select -Mr.Mrs.Ms. Full Name * Position * Nationality * Email * Mobile phone number Human Resources Manager (facultative) Title (Mr., Mrs., Ms.) - None -Mr.Mrs.Ms. Full name Nationality Email Mobile phone number Accountant / Finance Manager (facultative) Title (Mr., Mrs., Ms.) - None -Mr.Mrs.Ms. Full name Nationality Email Mobile phone number Description of company for Members Directory (1000 signs maximum) * Key facts and figures for Members Directory (1000 signs maximum) * Logo of company * Files must be less than 2 MB.Allowed file types: gif jpg jpeg png eps ai. Picture to illustrate company in our Members Directory * Files must be less than 2 MB.Allowed file types: gif jpg jpeg png psd. Picture of main contact * Files must be less than 2 MB.Allowed file types: gif jpg jpeg png. Brochure or document with a download link from our website Files must be less than 2 MB.Allowed file types: jpg jpeg png pdf doc. I CHOOSE THE FOLLOWING MEMBERSHIP * Partner membership - $1,700 / year Corporate membership - $750 / year SME membership - $450 / year Organisation membership - $350 / year Individual membership - $200 / year Young professional - $150 / year YOUNG PROFESSIONAL - $150 Conditions: Under 30 years Young employee, young entrepreneur Limited to 2 years before upgrading for a different type of membership Nominative membership Benefits: Membership applied only to the person, not the other employees in the company No promotion of your company and activities Limitations on other benefits Please check all the other benefits on our website and/or contact us INDIVIDUAL MEMBERSHIP - $200 Conditions: Individual (nominative membership) Benefits: Membership applied only to the person, not to the other employees in the company No promotion of your company and activities Limitations on other benefits Please check all the other benefits on our website and/or contact us ORGANISATION MEMBERSHIP - $350 Conditions: Non-profit organisation working/registered in Myanmar Benefits: Membership applied to all employees of the organisation Possibility to promote your organisation and activities Please check all the other benefits on our website and/or contact us SME MEMBERSHIP - $450 Conditions Small and medium foreign-invested companies (less than 200 employees worldwide) Myanmar companies with less than 200 employees Benefits: Membership applied to all employees of the company Possibility to promote your company and activities Please check all the other benefits on our website and/or contact us CORPORATE MEMBERSHIP - $750 Conditions: Large international companies (more than 200 employees worldwide) Myanmar companies with more than 200 employees Benefits: Membership applied to all employees of the company Possibility to promote your company and activities Please check all the other benefits on our website and/or contact us PARTNER MEMBERSHIP - $1,700 Conditions: Open to all companies Benefits: Membership applied to all employees of the company Possibility to promote your company and activities Full benefits and high visibility Please check all the other benefits on our website and/or contact us Term & Conditions I Agree * I have read, I understand, and I agree to abide by the terms and conditions set out in Annex 1 and with CCI France Myanmar's Private Data Policy. 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