Thank you for your interest in ASIS International Benelux chapter membership. Please provide the requested information below. Incomplete information will not be processed. All information provided will be used for internal purposes only. Membership in ASIS International Benelux chapter is nonrefundable, individual and is not transferable from one person to another.


I certify that all information herein is true and complete to the best of my knowledge and belief and authorize verification of this information, and release all concerned from any liability in connection therewith. I hereby apply for membership in ASIS International Benelux chapter and have read and understand the qualifications of membership, application fees, and dues payment requirements. I agree to abide by the ASIS International Benelux chapter bylaws and code of ethics, and agree to promote its objectives. Providing false or misleading information in this application form or failure to adhere to ASIS International Benelux chapter bylaws and code of ethics shall be grounds for denial of membership or expulsion from ASIS International Benelux chapter whenever discovered.

 

I have noticed the fact that membership of ASIS International Benelux Chapter costs € 120, - a year. If I'm accepted as a member of the ASIS International Benelux Chapter I'm automatically a member of ASIS International. This membership costs $ 195 extra per year. (about € 150, -)

 

First name *
Middle name
Last name *
Gender
Company name
Job title
Business address
Zip/Postale code
City
Province
Country
Business phone
Brief description of security duties
Home address *
Zip/Postale code *
City *
Province *
Country *
Home phone *
Prefered email address *
My email is * Business address
Private address

Eligibility information
 
Have you ever been convicted of a crime? * Yes
No
Did you ever had a professional membership, license, registration denied, suspended or revoked? * Yes
No