Application form for INDIVIDUAL MEMBERSHIP of PROJECT MESA

Please note that your organization becomes an Individual Member of Project MESA following the validation of your application by the MESA Organizational Partners.

IMPORTANT: Your organization must be a member of either ETSI or TIA to be able to obtain Individual Membership.

If you experience any difficulties in submitting this form, please send an e-mail to mesa@projectmesa.org

ORGANIZATION NAME

ADDRESS

ZIP/POSTAL CODE

TOWN

COUNTRY

URL

Please indicate below which ORGANIZATIONAL PARTNER you wish to be affiliated with:

ETSI TIA

AUTHORIZATION

The "Authorized Representative" is an individual within an organization authorized to commit a company to all or part of the scope and charter of Project MESA.

AUTHORIZED REPRESENTATIVE

DATE (dd-mmm-yyyy)

TITLE

NAME

ADDRESS (if different from above)

PHONE

MOBILE PHONE

FAX

E-MAIL

CONTACT INFORMATION

The "Principal Contact" will be used by Project MESA and its OPs for purposes of distributing general information.

PRINCIPAL CONTACT (if different from above)

TITLE

NAME

ADDRESS (if different from above)

PHONE

MOBILE PHONE

FAX

E-MAIL

Application form for INDIVIDUAL MEMBERSHIP of PROJECT MESA

AUTHORIZATION

AUTHORIZED REPRESENTATIVE

CONTACT INFORMATION

PRINCIPAL CONTACT (if different from above)

ADDITIONAL INFORMATION