European Deafblind Union - EDBU

Membership Registration Form

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(Please refer to the explanatory notes at the end of this form)

Name of your country:

If you wish to register your organisation, please state:

• The name of the organisation:
• The initials or acronym of the organisation:

If you wish to register yourself as a deafblind person, please state:

• Your surname:
• Your first name:
• Your job title:

What do you wish to do? (Please delete as appropriate):

• To join EDBU as a National Member (please refer to explanatory note 2).
• To join EDBU as an Associate Member (please refer to explanatory notes 2 and 3).
• To renew your EDBU membership.
• To continue your EDBU membership.
• To change or update your membership registration data.
• To cancel your membership of EDBU.

Member contact information.

Postal address (including your country):

Postal code:

Telephone and/or Fax numbers (please include country and area codes):

E-mail: Website:

Details about the organisation being registered.

This organisation is (please delete as appropriate):

• A registered and independent national organisation of deafblind people.
• An organisation of the deafblind affiliated to an organisation of either blind people or deaf people.
• An organisation of the deafblind that is attached to another type of association or institution.

The name of the president (or chairman) of the organisation:
Address of the president:
E-mail of the president:
Is the president deafblind? YES - NO (please delete as appropriate)

Name of the organisation's representative in EDBU (please note that representatives must be deafblind):
Address of the representative:
E-mail of the representative:
Position of the representative in the organisation:

Membership of the organisation.

• How many members of your organisation are deafblind?
• How many members of your organisation are not deafblind?

Involvement of deafblind persons in the governing body of the organisation.

• How many members of the organisation's governing body are deafblind?
• How many members of the organisation's governing body are not deafblind?

When was your organisation founded?

What is the official Registration Number of your organisation in your country? (Please provide the number given by the national authority which keeps the register of all formal organisations such as yours):

What is the Company Identification Number of your organisation? (Please provide your organisation's number on your country's national register of Companies):

Are there any other deafblind organisations in your country?
YES - NO (please delete as appropriate)

If yes, please state name(s) and contact details of any such organisation(s):

If you have any other comments, please write them here:

Please report any changes to us in the future. Thank you.

I declare that all of the above data is truthful and corresponds to reality.
Date:
Place:
Name of person that filled out the registration form:

To be sent to Geir Jensen, Secretary General of the EDBU, on fndb@fndb.no

Explanatory Notes:

1. Membership of EDBU is open to deafblind organisations and deafblind individuals only. A deafblind organisation is an organisation that has a governing body (e.g. an Executive Committee) which has a majority of deafblind people, and is elected by the deafblind membership at regular intervals.
2. Each country can only have one National Member. If two or more deafblind organizations operate in a country they must agree among themselves on which one of them shall be the National Member. The others can be Associate Members.
3. A deafblind individual may only apply for Associate Membership.

(2010-01-07)