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API Online Membership Application Form.

Annual Membership fees may be paid directly to the API Secretariat or via bank transfer.

All fields marked * are required.

First Name*

First Name

Surname*

Surname.

Place of Birth*

Place of Birth

Date of Birth*

Date of Birth

Current Nationality*

Current Nationality

Belgian Residency Nr*

Belgian Residency Nr

Home Address*

Home Address

Home Phone*

Home Phone

Office Address*

Office Address

Office Phone*

Office Phone

Office Fax*

Office Fax

Mobile*

Mobile

Email*

Please let us know your email address.

Employment Status*

Staff Part TimeFreelanceRetired

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Type of Media*

Please Select NewspaperMagazineOnlinePhotoRadioTVAgency Invalid Input

Media Name*

Please write a subject for your message.

Media HQ Address*

Media HQ Address

Other Activities*

List any other professional activities you may have besides journalism. If journalism is your sole activity, please type "NONE" Other Activities

*

I agree that my professional (not private) details be made available to non-commercial economic, scientific or cultural institutions for the organisation of press conferences

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reCAPTCHA*

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