INSTITUTIONAL MEMBERSHIP APPLICATION FORM This form is to be completed (PLEASE WRITE LEGIBLY) and returned to your National Committee Membership * New Membership Membership Renewal Membership Number Name of institution in English * Name of institution in your language Date of establishment Website Name of your Museum Director Institution contact details Mailing address Postal code E-mail address City Telephone Country - None -AfghanistanAland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBritish Virgin IslandsBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCaribbean NetherlandsCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongo (Brazzaville)Congo (Kinshasa)Cook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHondurasHong Kong S.A.R., ChinaHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyIvory CoastJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacao S.A.R., ChinaMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern Mariana IslandsNorth KoreaNorwayOmanPakistanPalauPalestinian TerritoryPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarReunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluU.S. Virgin IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUnited States Minor Outlying IslandsUruguayUzbekistanVanuatuVaticanVenezuelaVietnamWallis and FutunaWestern SaharaYemenZambiaZimbabwe FAX Name and position of person to whom correspondence should be addressed Contact details for representatives Representative 1 Name and surname Position E-mail address Telephone InternationalCommittee membership * Representative 2 Name and surname Position E-mail address Telephone InternationalCommittee membership * Representative 3 Name and surname Position E-mail address Telephone InternationalCommittee membership * Institutions can appoint representatives as voting members for International Committees. The same representative can be appointed to three different International Committees or three different representatives can be appointed to one of up to three InternationalCommittees. These representatives may also choose to receive information, without being voting members, from up to three (3) International Committees. If you wish to find out more about this opportunity and benefit from memberships to InternationalCommittees, please contact the ICOM Secretariat (tito.chan@icom.museum) Category of membership: * - Select -Regular I (voting) = operating budget* < €30.000Regular II (voting) =operating budget* from €30.000 to €100.000 Regular Ill (voting) =operating budget* from €100.000 to €1.000.000 Regular IV (voting)= operating budget* from €1.000.000 to €5.000.000 Regular V (voting) =operating budget* from €5.000.000 to €10.000.000 VRegular VI (voting) =operating budget*> €10.000.000Sustaining (voting)Contributing (voting)Supporting (non-voting) The operating budget concerns the whole expenses..of the institution, excepting capital expenditures PLEASE NOTE: Membership is annual and runs fro ' January 1 to December 31 of the year in which subscriptions are paid. New memberships received after September 30 will become effective as fromJanuary 1 of the following year unless otherwise indicated. Language for correspondence (tick one) : * English French Spanish A.CATEGORY OF I NSTITUTION: * - Select - Botanical GardenConservation Institute CulturalCentre Exhibition Gallery Library/Archives Museum Natural Park/Animal Reserve Research/Training Institute Zoological Garden/AquariumOther (please specify): B. GOVERNING STATUS: * - Select -Association County Foundation/Society Municipal National PrivateProvincial Regional UniversityOther (please specify): C. TYPE OF COLLECTION: * - Select -Agriculture/RuralHeritageApplied Arts Archaeology AchitectureChildren's MuseumCostumeDecorative Arts I DesignEco museumEducationethnology/EthnographyFine ArtHistoric HouseHistoryIndustrial HeritageLiteratureMaritimeMedicineMilitary HistoryModern & Contemporary ArtMoney & BankingMusical InstrumentsNatural HistoryOpen-airPerforming ArtsPhotographyRegional/LocalScience & TechnologySculptureSportsTransport & CommunicationsOther (please specify): Note: The above information will be automatically processed to ensure your receipt of services from ICOM and will also be transmitted to International Committees. In conformity with the French law on Informatics & Civil Liberties (Jan. 6, 1978, rev.) you have the right of access and to modify the information that concerns you. declaration * I declare that I am eligible for membership of the International Council of Museums (ICOM) and wish to become a member of ICOM. I do not engage in dealing (i.e. buying and selling for profit) in the field of cultural property and accept the ICOM Code of Ethics for Museums. Applications are subject to approval and processing can take up to 6 weeks, payment details will be shared once application is approved. CAPTCHAThis question is for testing whether or not you are a human visitor and to prevent automated spam submissions.