Membership Form 1. General Information 2. Membership Fee Please tick the below box relevant to your company * Global Revenues below €150,000 – £250 Annual Membership FeeGlobal Revenues between €150,000-€500,000 – £395 Annual Membership FeeGlobal Revenues between €500,000-€1m – £495 Annual Membership FeeGlobal Revenues between €1-€3 million – £895 Annual Membership FeeGlobal Revenues between €3-€5 million – £995 Annual Membership FeeGlobal Revenues between €5-€10 million – £1,750 Annual Membership FeeGlobal Revenues between €10-€15 million – £1,995 Annual Membership FeeGlobal Revenues between €15-€20 million – £2,200 Annual Membership FeeGlobal Revenues between €20-€50 million – £3,300 Annual Membership FeeGlobal Revenues above €50 million – £5,500 Annual Membership Fee 3. Declaration of Independence A Certified Provider Member must attest that they do not derive their revenue primarily from investment banking, underwriting or corporate broking, proprietary trading or market making, management consultancy services for clients other than investors, or from companies that were the subject of this research. I hereby confirm that the: Applicant is not in the business of providing investment banking services or management consulting services to publicly-traded companies * TrueFalse Applicant is not affiliated with, or a subsidiary of, any entity that provides investment banking services or management consulting services to publicly-traded companies * TrueFalse Applicant's primary revenue source is not from companies who are themselves the subject of the applicant's research coverage * TrueFalse Applicant is in good standing with all relevant regulatory authorities * TrueFalse Applicant is not operating an Expert Network Business * TrueFalse The undersigned confirms the accuracy of these statements. Date * 4. Additional Information We would be grateful for prospective members to send a brief company background, maximum 100 words. This description will be used on the www.euroirp.com website under the member's listing. Please use below space to provide details of your company background. Please also advise if your firm is regulated, and if so by which bodies, and whether clients are institutional or individual investors. It would be useful for applicants to forward sample(s) of their research to support their application together with the latest copy of their financial statements. They can either do this by attaching them below, or by sending them through email to sue.westwood@euroirp.com. Send Files Through Form Research Samples File Upload (allowed: doc, docx, pdf; max: 3MB) File Upload (allowed: doc, docx, pdf; max: 3MB) File Upload (allowed: doc, docx, pdf; max: 3MB) Financial Statements File Upload (allowed: doc, docx, pdf; max: 2MB) File Upload (allowed: doc, docx, pdf; max: 2MB) File Upload (allowed: doc, docx, pdf; max: 2MB) [anr_nocaptcha g-recaptcha-response] Δ