Joining the ITNEA

You will have checked that you meet the criteria for membership

THIS FORM IS SUSPENDED  please return to joining page

You have elected to complete this e-form to submit your application to ITNEA

A. Please complete this form in full to apply for membership of the ITNEA. * Indicates a required field/set. Before submitting the form please take copies for yourself. You can also copy the acknowledgement page which displays fields & content only.

This is an ITNEA application form

* Indicates a required field/set

Applicant

First Name *

Last Name *

email * #

# If you have an alternative email please also enter above separated by a " ; "

Please provide an email address that is expected to last across changes in NED roles. Please ensure your email package and ISP have jane.tozer@virgin.net registered as a safe sender. Email is our preferred form of communication. You will receive event invitations and other ITNEA information via email. You may opt out of emails with advertisements for chairmen and NEDs below.

Quoted or near float TMT Companies where I am a Non-executive Chairman (Chair) or Director (NED)

Please enter each company, and select whether listed or not - Type - and your non-exec Role. See Further information below for data on roles that do not match this set of company fields

1 *	Company Type of Co. Role

2
3

Preferred address for (very rare) postal mailings

Please supply ,as we find that many companies do not forward non-executive's email, or delay

Company	Please ONLY use if Company needed in address
Line 1 *
Line 2
Line 3
Line 4 *	Town/City preferred
Line 5	County , or Country if not UK
Post code *

Other contact details

Telephone *
Mobile *
Fax

I would like to join the ITNEA

Optional non-executive opportunity advertising service

I understand that the ITNEA may email me details of chairman / non-executive and related opportunities from time to time. Please change to "No" if you do not wish to receive such emails. You can change to "No" later, if so wished.

Further Information

This box is for you to add further information. Please list any other directorships, listed and unlisted, plus any other data in support of your application. This box may also be used to provide free format data if applying with a near match to the ITNEA criteria. For any "near float" companies above please indicate timescale/progress stage. Note 5 lines x 100 character field limit.

Please save/print for your record before submitting