Become an associate member of the High North Alliance  by printing out the form below, filling it out and faxing it to us (+47 76 09 24 50).

Mr./Miss/Mrs.______

Name_________________________________________________

Address_______________________________________________

_______________________________    Postal code____________

Country_______________________________________________

Telephone number_______________________________________

E-mail________________________________________________

I would like to support the work of the High North Alliance with the amount of ____________________  made in (tick): (   ) NOK  (   ) USD  (   ) GBP

I would like to make the payment (tick one):                                            (   ) Once only (   ) Yearly (   ) Monthly

please charge my (tick): (   )Euro card (   )Visa (   )Master card               (   )American Express

Credit card number:_______________________________________

Expiry date (month/year): ____/____

Cardholder's signature:___________________________________

The High North Alliance thanks you for your support.