Please enable JavaScript in your browser to complete this form.1. BUSINESS INFORMATIONPrimary Contact PersonTitle *Full Name *FirstLastCompany Name *Company Registration No. *VAT Registration No. *Physical Address *StateLocal Government Area (LGA) *Region or Geopolitical ZoneOffice Telephone NumbersMobile Telephone NumbersEmail Address *Website / URLTotal Number of Employees in the CompanyNumber of Skilled Employees(Working Directors, Senior Managers, Artisans and those Performing work of Artisans)Number of all other Employees(All Administrative, Sales, Technical and Non-technical Staff)2. DETAILS OF DIRECTORS/OWNERSDirector/Owner 1TitleFull NameFirstLastMiddle Name/Other NameDate of BirthGenderMale (M)Female (F)NationalityImmigration Status (For Foreigners)Residential AddressStateLocal Government Area (LGA)Region or Geopolitical ZonePersonal Telephone NumbersPersonal Email AddressDirector/Owner 2TitleFull NameFirstLastMiddle Name/Other NameDate of BirthGenderMale (M)Female (F)NationalityImmigration Status (For Foreigners)Residential AddressStateLocal Government Area (LGA)Region or Geopolitical ZonePersonal Telephone NumbersPersonal Email AddressDirector/Owner 3TitleFull NameFirstLastMiddle Name/Other NameDate of BirthGenderMale (M)Female (F)NationalityImmigration Status (For Foreigners)Residential AddressStateLocal Government Area (LGA)Region or Geopolitical ZonesSelect RegionNorth Central (NC)North East (NE)North West (NW)South East (SE)South South (SS) (Niger Delta Region)South West (SW)Personal Telephone NumbersPersonal Email Address3. AREAS OF SPECIALIZATIONSelect your area of specializationConsumables SuppliersPaper MerchantsEquipment SellersDigital PrintersInkjet Large Format PrintersPrepress Operatives - CTP/CTCPScreen PrintersTextile Printers & Garment DecoratorsCommercial PrintersPaper ConvertersPackaging PrintersFlexo, Corrugated & Mono CartonsGraphics DesignersSecurity PrintersNewspaper PrintersTechnical Support ProvidersBook PrintersConsultancyOffset PrintersOther area of specialization not mentioned above? Specify here4. EQUIPMENTDetails of Key Plant Utilized (If insufficient space, please list separately)SN BRAND, MODEL & YEAR OF MANUFACTUREUSEQUANTITY5. INDUSTRY CLUSTER AND ECOSYSTEMCIPPON provides the above interest groups and associations with secretarial services, information, dissemination, facilitation of meetings, and representation on external and/or international bodies. Associate members, may provide input but will not haveany voting right. Please indicate which aligns with your business.Consumables SuppliersPaper MerchantsEquipment SellersDigital PrintersInkjet Large Format PrintersPrepress Operatives - CTP/CTCPScreen PrintersTextile Printers & Garment DecoratorsCommercial PrintersPaper ConvertersPackaging PrintersFlexo, Corrugated & Mono CartonsGraphics DesignersSecurity PrintersNewspaper PrintersTechnical Support ProvidersBook PrintersConsultancyOffset PrintersIf Other (Specify here5. ELECTRONIC COMMUNICATIONINVOICES/NEWSLETTERS - Please indicate whether or not you would like to receive our newsletter and circulars by e-mail or post (Please note that e-mail will eliminate any postal delays.) *E-mailPostTerms of Service *Please confirm your acceptance of electronic invoicingBy signing this membership application form, you have hereby certified that the above mentioned details are true to the best of your knowledge and the Directors/Owners of the member company bind themselved jointly and severally for all debts which the member company may at anytime owe to CIPPON and that should the member company resign, will give three CIPPON (3) months written notification and ensure that all arrear subscription are paid in full. You agree to abide by the Code of Ethics as embodied in the CIPPON Code of Conduct and Ethic and agree to the collection of information and it`s use as described on page 7. You further agree to receive notices from CIPPON from time to time. I I the undersigned hereby state that i am authorised to conclude this agreement. I further agree to abide by the CIPPON code of ethics and to fulfill the terms and conditions as laid out herein.Request Certification