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MEMBERSHIP APPLICATION FORM

COMPANY OR INDIVIDUAL NAME: *

ADDRESS:

Ville

Code postal

TELEPHONE(S):

E-MAIL:

WEBSITE:

YEAR BUSINESS STARTED:

1- If U.S., what is your Home State? (Headquarters in the United States of America)

City:

State:

Zip Code:

2- If Malian, please specify name(s) & address of U.S. Company(ies) your company is affiliated with (if applicable)

NAME OF CHIEF EXECUTIVE:

SALES TERRITORY BY CITIES/REGIONS/COUNTRIES (if applicable):

AUTHORIZED DISTRIBUTORS BY COMPANY(IES)/PRODUCTS (if applicable):

COMMERCIAL REFERENCES IN THE U.S.A (if any):

If you select General Trade & Commerce, please specifyImporterExporter

PLEASE LIST YOUR PRINCIPAL PRODUCT(S) OR SERVICE(S)

1- PRODUCT(S):

2- SERVICE(S):

MISCELLANEOUS INFORMATION

Does your company have any business transactions with any American company?YesNo

Do you have a business partner in America?YesNo

Will you be interested in serving on the chamber’s committee?YesNo

Please select a category of membership down below