Institution Member Application

Name of local institution / association

Country Name

Name of person submitting application

Name of President/Chairman:

Physical address

Postal address

Email of local institution / association

Facsimile

Telephone number

Trade name of practice (if other than legal name)

Full name of duly authorised person

Email

Number of full members

Number of student members

Annual fees in South African Rand 1 July 2022 - 30 June 2023 Annual fees in South African Rand 1 July 2022 - 30 June 2023 Catagory A: Large associations/institutes eg Nigeria, South Africa ZAR 13,700 Catagory B: Medium associations/institutes eg Ghana, Kenya ZAR 8,100 Catagory C: Small associations/institutes eg Mauritius, Namibia, Tanzania, Uganda ZAR 4,200 Catagory D: Smaller associations/institutes eg Botswana, Lesotho, Malawi, Swaziland, Rwanda, Zambia, Zimbabwe, ZAR 2,950 Catagory E: One-representative associations / institutes eg Angola, Mozambique ZAR 1,000

Remarks