| 1 | Applicant | |
| Full name of individual / company / organisation | |
| Nominated Representative (If professional / corporate / collective membership) | |
| Nature of Business | |
| Street Address |
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| Postal Address |
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| Tel No | |
| Fax No | |
| Docex Number City |
E-mail address
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| 2 | Type of Membership Applied For
(Refer to Membership and Rates Info) Individual Membership Professional Membership * Corporate Membership ** Academic Membership *** Collective Membership Affiliate Membership Honorary Membership |
* In the case of a partnership or professional company, how many partners / directors are there?
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** Please send us your annual report giving an indication of the size of your enterprise / group and the range of its activities.
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***I confirm that I am a teacher / student at a university or technikon or other institution recognised by AFSA for this purpose. I accept that my status will be subject to review should my circumstances change. (In the case of a student, please send us a proof of registration)
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| 3 | Other relative information |
| 3.1 | Additional Addresses to which AFSA mail is to be sent (send us schedule of addresses) | |
| Postal Address |
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| 3.2 | Name of an alternative person to represent the firm / organisation / in AFSA | |
| Postal Address |
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| 4 | Subscription |
Signature
(mmm unique code or password) |
| For and behalf of (applicant) |
| Capacity | |