Polykum

Membership Application

    Membership Application

    1. Type of Membership


    I hereby apply for membership* in the "Association for the Promotion of Polymer Development and Plastics Engineering in Central Germany – POLYKUM e.V."

    2. Personal Information








    3. Company / Institution Details




    Represented by (if different from details in section 2):










    3. Contact Details of the Prospective POLYKUM Member





    4. Membership Fee

    Membership payment:*




    I confirm that I have read the privacy policy and the information on the right of withdrawal. (The request will be transmitted securely via https to the server. The information provided will be used to process this request.)