Associate Member Application Form

data of organisation

* mandatory field

Name of Institution / Organisation*

Contact Person Surname*

Contact Person First name*

Contact e-mail address*

Street*

Postal code*

City*

Country*

Phone number*

Fax

Website

Legal Structure*

Years of existence*

Core activities that relate to microfinance in Africa*

Parent Company (if any)

How did you hear about AMT?*

Comments