Design for All Foundation International Networks

MEMBERSHIP APPLICATION: EDUCATION CENTRES

1.  Please provide the following general information about your institution:

Registered organisation name
Registered name
in English (if different)
Tax identification number (if applicable)
Street address
City or Town / Postal/ZIP code
State/Province
Country
Number of employees
Website

2.  Billing address (if different from above):

Organisation name
Street address
City or Town / Postal/ ZIP code
State/Province
Country

3.  Please provide the name of the person with overall responsibility for the organisation (president, director, chancellor, head teacher...):

First name and surname
Title
Street address
City or Town /

Province/State

State/Province / Country
Telephone / Fax
Email
Date appointed / Date of appointment expected to finish (if any)

4.  Briefly describe your institution’s area(s) of activity, list the countries in which it is active and indicate the educational stage(s) offered:

Educational stage:

Preschool
Primary
Secondary (high school)
Further (16-18 college)
Higher (university)
Vocational / technical
Adult

5.  Appoint a member of staff to serve as primary contact. (This person should have general oversight of Design for All/Universal Design activities as part of his/her responsibilities):

First name and surname
Position
Street address
City or Town / Postal/ ZIP Code
State/Province / Country
Telephone / Fax
Email

6.  Please provide contact details for the member of staff responsible for communications:

First name and surname
Position
Telephone / Email

7.  Please select the international networks in which you would like to be active and/or about which you would like to receive information from the list below:

Towns and Cities for All
User-Centred Business
Museum for All
Society for All

8.  Please indicate the annual membership fee payable by your organisation for the current year by placing an “X” in the appropriate box:

NATIONAL HDI (HUMAN DEVELOPMENT INDEX)
COMPANY SIZE / VERY HIGH
(1 - 0,78) / HIGH-MEDIUM
(0,77 - 0,48) / LOW
(0,47 – 0)
PROFESSIONAL (1-2)
AND INDIVIDUALS / 200 € / 170 € / 130 €
MICRO (3-10) / 500 € / 430 € / 330 €
SME (11- 250) / 1200 € / 1030 € / 790 €
LARGE (>250) / 2500 € / 2150 € / 1650 €

9.  Please provide contact details for the person completing this form:

First name and surname
Position
Telephone / Fax
Email

Date: Signature:

The annual fee (*)should be made via:

·  Credit card

·  Bank transfer

Bank: Banco de Sabadell, S.A.

Address: Consell de Cent, 21, 08014 Barcelona

Account holder: Design for All Foundation

Bank account: (IBAN) ES04 0081 0110 6100 0120 5825

BIC/SWIFT: BSABESBB

When making the transfer, please include the register number together with the name of the organisation submitting the entry.

Please send your completed form and the evidence of payment to: or by fax: +34 933717649

ü  After receiving your application our Foundation will contact you to welcome to the networks. Please note that your membership cannot be confirmed until we have received the Membership Fee. By way of this payment, the applicant accepts the Membership terms and conditions set out in this document. Please bear in mind that the Foundation reserves the right to deny membership if evidence of illegal activities by your company is found.

ü  To renew membership, fees should be paid every year within seven days of the date of the first payment. In the event of a fee alteration, members will be notified three months in advance.

ü  Any member of the networks can be expelled if there is evidence of involvement in actions against human rights and diversity, according to the criteria of the Design for All Foundation Board.

(*)The amount transferred for the membership of the Network should be considered a membership fee of an international organization; it does not constitute a rendering of professional services as defined in the 25th article of the Spanish Law 49/2002.

*In compliance with the established Organic Law 15/1999, December 13th, on the Protection of personal data, we remind you, through the completion of this form, that your personal details will be incorporated and filed in the Design for All Foundation, for the purpose of offering you our services and to be informed of the initiatives and news updates in the field of Design for All. Therefore, you are notified of the possibility to exercise your rights regarding access, rectification, cancellation and opposition of your personal data. You may contact the Foundation at or at Carrer Piquer, 29, Baixos 1, 08004-Barcelona, Spain.

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Design for All Foundation: Carrer Piquer, 29, Baixos 1ª (08004-Barcelona, Spain)

Tel: +34 934705118 / Fax: +34 933717649 /