MEMBERSHIP APPLICATION FORM

Individual/Professional R300 **** Student R150 Membership Fees to be paid by 31 January of each year. Please EMAIL your form and proof of payment to admin@iap2sa.org

Compulsory fields are marked with an *. Without these your registration cannot be processed.

TITLE: NAME*: SURNAME*: TYPE OF MEMBERSHIP (Individual/Professional or Student) IAP2 SA MEMBERSHIP NUMBER (If applicable): COMPANY WHERE EMPLOYED/ OR ACADEMIC INSTITUTION*: PROVINCE*: CITY / TOWN*: POSTAL ADDRESS (Including postal code): OFFICE TELEPHONE*: MOBILE PHONE* (if available): FAX NUMBER: OFFICE EMAIL*: ALTERNATIVE EMAIL: LANGUAGES IN WHICH YOU CAN OFFER SERVICES

I have completed the IAP2 CERTIFICATE COURSE in PUBLIC PARTICIPATION I have completed the IAP2 Course EMOTION, OUTRAGE & PUBLIC PARTICIPATION

Yes, please contact me by email

P.O. Box 31355, Braamfontein, 2017, South Africa

E-Mail: admin@iap2sa.org

Web: www.iap2sa.org

FULL-TIME STUDENT INFORMATION *Registration number (Attach proof of student registration)* *Level of study (Tick one) *Field of Study Degree Post Graduate Other

I HAVE READ AND COMMIT TO THE IAP2 CODE OF CONDUCT AND CORE PRINCIPLES

SIGNATURE__________________________________________________DATE:__________________

IAP2 SA BANK DETAILS BANK: Absa, ACCOUNT NAME: IAP2 SA, ACCOUNT NUMBER: 9249611388