WISTA Denmark APPLICATION FORM

NAME:_________________________________________________________________

TITLE:__________________________________________________________________

COMPANY:_____________________________________________________________

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ADDRESS:______________________________________________________________

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______________________________________________________________Denmark.

PHONE:____________________________EXT/ DIRECTLINE:____________________

FAX:__________________________TELEX:___________________________________

PRIVATE ADDRESS (OPTIONAL):__________________________________________

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PRIVATE PHONE:__________________________FAX: _________________________

EMAIL ADDRESS________________________________________________________

PROFESSIONAL PROFILE : _______________________________________________

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COMPANY DESCRIPTION:_______________________________________________

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PARENT COMPANY:_____________________________________________________

MOTHER TONGUE: _______________OTHER LANGUAGES:____________________

Print name______________________________Signature__________________________

Please send this application form to

WISTA Denmark, c/o Marianne Meinertz, 386, Vedbæk Stradvej, DK-2950 Vedbæk