Firm Level Assistance Program

PITA Technical Consultancy

Registration Form

10

Company name:
Main Business:	Software Services
Representative:		Title:
Address:		City:
E-mail:
Tel:		Fax:
Estimated Time Required

Please note the following: 
1. You will be charged at daily rate of 35$ paid to PITA. Attached time sheet should be signed by you and the consultant.
2. Advance payment of $500 for PITA members (or $700 non members) with the submission of the Application.

Company Signature and Stamp	Consultant Signature
Date	Date

 Please return this form by email to: register@pita-palestine.org , subject:
Technical Assistance.