Join the Basel Action Network!
Please print and fill out this form, then fax it to 1-206-652-5750 or mail it to:
Basel Action Network
206 First Ave. S., Suite 410
Seattle, WA 98104
USA
| Organization Name: | ___________________________________________________ |
| Contact Person: | ___________________________________________________ |
| Position: | ___________________________________________________ |
| Mailing Address: | ___________________________________________________ ___________________________________________________ ___________________________________________________ |
| E-mail: | ___________________________________________________ |
| Website: | ___________________________________________________ |
| Phone: | _______-________-___________________________ |
| Fax: | _______-________-___________________________ |
| Campaign Interest: | ___________________________________________________ |
| How did you hear about BAN? | ___________________________________________________ |
Please note, this form is NOT for those who are interested specifically in our e-waste program, the e-Stewards Initiative. If you are a company seeking to become a part of the e-Stewards Initiative, please visit www.e-Stewards.org for instructions.