Declaration of Admission  
Friend: Developer of the DAISY Consortium

Please type or print the information below and send by mail to: 
Mr. Bernhard D. Heinser
Chief Financial and Development Officer, DAISY Consortium
c/o Swiss Library for the Blind and Visually Impaired
Grubenstrasse 12
CH - 8045 Zurich
Switzerland

Please send an electronic copy by email to: 
online-membership-application (at) daisy.org


Name of organization: (Original name):

________________________________________________________________

Name of organization: (English name):

________________________________________________________________

Please give a brief description of your organization's activities, in English:

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Our company is a (please mark one):

__ for-profit organization        __ non-profit organization 

Address:

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Phone:   		__________________________________

Fax:  			__________________________________ 
	
General E-mail: 	__________________________________ 

Homepage:  		__________________________________ 
	
Last name, first name of the authorized representative: 

			__________________________________ 
	
E-mail: 	__________________________________ 

Last name, first name of second contact: 

			__________________________________ 

E-mail: 	__________________________________ 

As the authorized representative of

	______________________________________________

I hereby declare that I have taken cognisance of the Articles of Association of the DAISY Consortium and accept the Regulations relating to Friends of the DAISY Consortium in all respects. In particular I declare that our organization will do nothing that could be detrimental to the work of the DAISY Consortium.
 
 
Friend: Developer of the DAISY Consortium

Signed: 		__________________________________


(Name, typed) 	__________________________________


Date: 			_________