Distributor's Application

Company Details

Company Name

Address Line 1

Address Line 2

Address Line 3

City

County/ State

Postcode

Country

Website

Telephone Number

Parent Company (if any)

Other Companies in group (if any)

Year of Company Formation

Company ID

Company VAT Number

€ Annual Turnover in products etc

Key Person's Contact Details

The Key Person is the main person that EPDA will communicate with regarding the company's membership and their involvement in EPDA events and meetings.

Title

First Name

Last Name

Position

Email Address

Verify Email Address

Telephone Number

Voting Member

The Voting Member is the person that will represent the company at the Annual General Meetings (AGMs) and provide the company's vote the agenda items.

First Name

Last Name

Position

Email Address

First Reference

Name:

Company:

Address Line 1:

Address Line 2:

Address Line 3:

City:

County/State:

Postcode:

Country:

Email:

Telephone Number:

Second Reference

Name:

Company:

Address Line 1:

Address Line 2:

Address Line 3:

City:

County/State:

Postcode:

Country:

Email:

Telephone Number:

EPDA Membership Directory:

The EPDA Membership Directory is open to the public on the EPDA website and is printed in the annual conference booklet which all conference delegates receive. The following information is included in the directory:

The name of the key contact
The company address.
The specified membership directory email address

Please include my company in the annual conference membership directory.

Please include my company in the online membership directory

Please provide email address here:

Communications with EPDA

Please tick to agree you are happy to receive communications from EPDA, regarding your membership, renewal invoices, directory checks, Newsletters, surveys, events, EPDA specific marketing opportunities and general information, by email, telephone and post.

I agree

Billing Details

The Billing Address is different to the Contact Address

The Contact Address is the same as the Billing Address

Company Name

Address Line 1

Address Line 2

Address Line 3

City

County/State

Postcode

Country

Email Address

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EPDA Distributor's Membership Application Form

Company Details

Key Person's Contact Details

Voting Member

References

First Reference

Second Reference

Company Information

Do you have your own sales network?

Please tick if at least 25% of your gross sales are from Distribution?

Primary Product Focus

Preferences

Please tick to confirm you have read and accept the EPDA code of practice.

EPDA Membership Directory:

IAPD Magazine

Social Media

Communications with EPDA

Registration Fee

Billing Details

Summary

Terms and Conditions

Thank You