Star

Primary Contact Details (only primary contact will have voting rights and receive Rotoworld)

First Name *

Last Name *

Designation *

Email *

Mobile No.*

Type of Ownership *

Sole Proprietorship

Private Limited Company

Partnership

Limited Company

University / College / Institute

COMPANY / ORGANIZATION DETAILS

Company / Organization Name *

Address *

City *

State *

Postcode *

Country *

Phone *

Fax

Website

Company / Organization’s Representative Contact

Please list the name of the Company / Organization’s representatives to be listed in the Membership Directory and included on the StAR mailing list. Up to 2 names are listed in the directory and up to 3 people can receive StAR mailings.

S.No	Name Listed In Directory	StAR Mailing List
1.	Yes	Yes
2.	Yes	Yes
3.	No	Yes

Qualification for StAR membership

Please provide 2 references of existing StAR members in good standing to qualify you for membership.

REFERENCE : 1

Name

Phone

Company

REFERENCE : 2

Name

Phone

Company