CORPORATE MEMBERSHIP APPLICATION FORM

Name of Company:
_____________________________________________________________
Year Founded: _______ Phone/s:____________________________ Fax:
__________________
Principal Company Address:
_____________________________________________________
Web Site/s: ________________________, ____________________,
_____________________
Products/Services/Brands:
_______________________________________________________
TYPE OF COMPANY
___Internet Portals/Online Publishers ___Mobile Content Provider
___Wireless Operator
___Digital Marketing Companies ___Advertising/PR Companies
___Brands/Advertisers ___Digital Research Companies
___Government
___Other ______________________________________________________________
Names of the two Company Representatives who will participate in IMMAP
meetings & events:
Primary Representative
Mr/Ms ______________________________ Designation:
_________________________Age __
E-mail:______________________________ Mobile phone:
______________________________
Secondary Representative
Mr/Ms ______________________________ Designation:
_________________________Age __
E-mail:______________________________ Mobile phone:
______________________________
Reason(s) for joining IMMAP:
______________________________________________________________________________
______________________________________________________________________________

Principal ways the applicant company may contribute to the

objectives & activities of IMMAP:
______________________________________________________________________________
______________________________________________________________________________
On behalf of our company, I affirm that the above are correct and updated
when submitted.
Please include me in your mailing list <via email> and/or <mobile> for the
following (check appropriate box):
___ IMMAP Newsletter
___ IMMAP Event Invites ___ Members
Event Invites
___ Survey Questionnaire ___ Membership Update
Name and Signature: __________________________________ Date:
_________________
Please include a jpeg/pdf copy of your SEC cerficate when you e-mail
this Application Form to:
aye.ubaldo@immap.com.ph ; cc: secretariat@immap.com.ph