Membership Form CC BE 2016
Thank you for registering your membership with

Please fill out this form and send us the logo of your company via email to so we can add you as a member on our website:

Should you have any questions, please do not hesitate to contact Hans Cleemput, managing director of via or +32489317043.

Company name (membership) *
Please add the brand name of your company that can be used in our member list en in all of our communications. This company name may differ from the official company name, used for the invoice details.
Your answer
Membership Type *
Premium Partner
Invoice details
Official company details for the invoice process
Company name & form (bvba, sprl, nv, sa, vzw, asbl...) *
Your answer
Address *
Your answer
VAT-number *
Your answer
General phonenumber
Your answer
Company email address
Your answer
Your answer
Name *
Your answer
Function *
Your answer
Email address *
Your answer
Phone *
Your answer
I'd like to add extra contactpersons
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