All fields marked with an asterisk (*) are required

Member Details

Title

*

Gender

*

First Name

*

Age Group

*

Surname

*

Date Of Birth

Date Of Birth

ID No

*

Language

Other

Ethnic Group

*

Fax

Code ( ) ( )

Telephone

Code ( ) ()

Email

*

Cell

Physical Address

*

Company Name

Physical Code

() *

Type of Company (area of speciality)

Postal Address

Job Title

*

Postal Code

()
*

Region

Name of Entity To Invoice *

Name of Entity to Invoice is not listed

*
*
MEMBERSHIP TYPE   2012 FEES DISCOUNT MEMBERSHIP FEE
CORPORATE MEMBERSHIP (Person Specific)/INDIVIDUAL MEMBERSHIP Per Member R1120.00 + R156.80
VAT = R1276.80
R120 + VAT R1000 + VAT
INDEPENDENT RETAILERS/FRANCHISEES/GOVERNMENT MEMBER
(Local,Provincial and National officials/employees & Academia)
Per Member R650.00 + R91.00
VAT = R741.00
R150 + VAT R500 + VAT
FUTURE LEADERS (Under 30's) / STUDENTS (Registered Students with Student card) Per Member R350.00 + R49.00
VAT = R399.00
R50 + VAT R300 + VAT
*





*

Do you wish to receive: