Prefix	: Mr. Mrs. Ms. Dr.
Full Name*	(Last Name) :	(First Name)
Job Title*	:
Office Phone*	Country Code Area Code Phone Number :
Mobile	Country Code Area Code Phone Number :
Fax*	Country Code Area Code Phone Number :
Company Name*	:
Company Address 1*	:
Company Address 2	:
Company Address 3	:
Country*	: --- Afghanistan Africa Albania Algeria Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Ashmore and Cartier Islands Australia Austria Azerbaijan Bahamas Bahrain BakerIsland Bangladesh Barbados Bassasda India Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Bouvet Island Brazil Brunei Bulgaria Burkina Faso Burma Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Clipperton Island Cocos (Keeling) Islands Columbia Comoros Cook Islands Coral Sea Islands Costa Rica Croatia Cuba Cyprus Czech Denmark Djibouti Dominica Dominican Republic Dubai East Timor Ecuador Egypt El Salvador Eritrea Estonia Ethiopia Europa Island Faroe Islands Fiji Finland France French Polynesia Gabon Gambia Georgia Germany Ghana Gibraltar Glorioso Islands Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guiana, French Guinea Guinea Bissau Guinea, Equatorial Guyana Haiti Honduras Hong Kong Howland Island Hungary Iceland India Indonesia Iran Iraq Ireland Isle of Man Israel Italy Ivory Coast Jamaica Jan Mayen Japan Jarvis Island Jersey Johnston Atoll Jordan Juande Nova Island Kazakhstan Kenya Kingman Reef Kiribati Korea, North Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macau Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Midway Islands Moldova Monaco Mongolia Montserrat Morocco Mozambique Namibia Nauru Navassa Island Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Northern Marianas Norway Oman Pakistan Palau Palestinian Territory Palmyra Atoll Panama Papua New Guinea Paracel Islands Paraguay Peru Philippines Pitcairn Islands Poland Portugal Puerto Rico Qatar Reunion Romania Russia Rwanda Saint Helena Saint Kitts and Nevis Saint Lucia Samoa Samoa, American Samoa, Western San Marino Sao Tome and Principe Saudi Arabia Scotland Senegal Serbia and Montenegro Seychelles Sierra Leone Singapore Slovak Rep. Slovenia Solomon Islands Somalia South Africa South Korea Spain Spratly Islands Sri Lanka Sudan Surinam Svalbard Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Tazmania Thailand Togo Tokelau Tonga Trinidad and Tobago Tromelin Island Tunisia Turkey Turkmenistan Turks and Caicos Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States Uruguay Uzbekistan Vanuatu Vatican City Venezuela Vietnam Virgin Islands, British Virgin Islands,US Wake Island Wales Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe
Billing Address 1 (If different from above)	:
Billing Address 2	:
Billing Address 3	:
Email*:	:
GENERAL INFORMATION
What is your Business Type*	:
What products / services do you offer*?	:
Number of employees*?	:
Are you a member of any other industry association(s)*?	Yes	No
If yes, please list	:
MEMBERSHIP TYPE
I am interested in* Becoming a founding member ($10,000 USD) subject to GPPA board approval.   becoming a member ($2,500 USD)   attending the first General Assembly of the GPPA   being visited by a GPPA representative   receiving regular information     Others (please state)
BUSINESS TYPE
Please choose at least one   Resin Producer   Pipes and Fittings Manufacturer   Consultants   Associations   Government & Authorities   Training and Education   Publications, Conferences and Exhibitions   Services- contractors   Services- Agents   Services- Compounding and Master-batch   Services- Labs & testing   Services- Equipment Suppliers   Other
TERMS & CONDITIONS
GPPA Membership Policy Membership in GPPA is open to any individual/company interested in the declared purposes of the academy. An individual/company seeking membership will be accepted as a member of GPPA upon submission, receipt, acceptance and processing of the required application materials, fees and assessments. All GPPA memberships are for the specific and sole use of the registered individual/company for whom payment is made and are non-transferable. Fees are non-refundable and subject to change at membership renewal time. Member rights include, but are not limited to, the opportunity to vote on GPPA general assembly annual meetings. Privileges are defined as those tangible and intangible benefits, products and services offered with membership in the academy. A violation of the terms stated in the GPPA code of practice is subject to the GPPA board review and may result in termination of membership. In order to join GPPA you will need to complete the online application form, agree to the terms and condition, and pay the annual fee. You will be notified by email when your membership renewal is due.
I agree to the terms and conditions of payment.

Payment Instructions:

By Direct Transfer Kindly wire the fund to: 

Account Name :          Gulf Plastics Pipe Academy
Account No :              011-194651-100 (USD)
Swift Code :               BBME AEAD

HSBC Bank Middle East Limited
P.O.Box 242, Abu-Dhabi, United Arab Emirates

GPPA respects your privacy and values your goodwill. The personal data you have provided will be used for GPPA’s purposes only. This includes sending you email updates on events organised by the academy, or to remind you about application deadlines for GPPA awards and business.