Become a part of Immunity for Health

Member application

GENERAL INFORMATION:

Company name *

Company description *“The company description (in English) will be available in the Member Database on the Immunity for Health website.”

Foundation date

High resolution logo *

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Membership Category

Website *

Telephone number *

Company's LinkedIn page *

Street Address *

City *

ZIP / Postal Code *

Country *

Billing address (if different from main address)

VAT number *

Number of FTE’s *

Are you a member of flanders.bio? *

Type of organisation *

Activities *

Therapeutic area *

CONTACT:

Company manager contact

First name *

Last name *

Email address *

Telephone number *

Communications contact

First name *

Last name *

Email address *

Telephone number *

Billing contact

First name *

Last name *

Email address *

Telephone number *

OTHER:

Are we authorized to share your email address with relevant parties? *

Cat.	Type	FTE	Membership Fee
A	Knowledge Institution	Research Group	€ 1100
B&C	Company/ Service Provider	< 5	€ 600
		5-19	€ 1210
		20-49	€ 2200
		50-249	€ 3300
		>250	€ 4400

Become a part of Immunity for Health

Member application

GENERAL INFORMATION:

CONTACT:

OTHER:

EFFECTIVE MEMBER – Category A

EFFECTIVE MEMBER – Category B

ASSOCIATE MEMBER – Category C