Membership Form — Holland House

Let’s work together.

Fill this form to apply for a membership at Holland House Panama

Type of membership

Please include your contact details:

First Name

Last Name

Job Title

Company Name

Website

http://

RUC number + DV

Office Phone

Country

(###)

###

####

Mobile Phone

Country

(###)

###

####

Company Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Description of business activities (max. 400 characters, to be used in publications)*

What are the main reasons you would like to join Holland House Panama?

*Please note that to be eligible for membership, companies are required to have a clear business relationship with the Kingdom of the Netherlands: e.g. companies with Dutch ownership or capital, distributor, representative or agent of Dutch goods or services and companies exporting goods or services to The Netherlands. Holland House Panama membership is subject to annual evaluation.

Other contacts from your company (for chamber communication and events)

Contact 1:

First Name

Last Name

Position

Phone

(###)

###

####

Contact 2

First Name

Last Name

Position

Phone

(###)

###

####

Please include your billing information and details for your invoice:

With this application, I agree to the annual membership of Holland House Panama and the conditions stipulated below

Membership fees are payable on an annual basis and cover the membership period 1 January to 31 December (calendar year). Membership fees are non-refundable. All memberships will be automatically renewed for one year. Cancellation requests must be done in writing at least one month before the new membership period starts (before 1 December). Membership applications are to be approved by the Board of Holland House Panama.

Yes, I agree

I agree to receive the bimonthly Holland House newsletter and other Holland House marketing emails.

Yes