Application for Membership form

Application for Membership form

Associated organisations

Annual Fee: R14270

Membership fee is for the period 01 January 2023 – 31 December 2023 irrespective of the date of joining.

Student Associations
Annual Fee: R14270

Membership fee is for the period 01 January 2023 – 31 December 2023 irrespective of the date of joining.

Corporate Organisations
Annual Fee: R14270

Membership fee is for the period 01 January 2023 – 31 December 2023 irrespective of the date of joining.

I hereby apply for/confirm my institution’s membership of IEASA and nominate the following individual/s to represent the institution. Institutional membership representatives must be nominated by the Head of your institution. When appointing a representative, the appointing authority of the Institutional Member, which should typically be the head of the institution, is expected to check that there is no conflict of interest between IEASA’s aims and objectives and the personal, professional or business interests of the person nominated to represent the institution for the purpose of the Association.
DETAILS OF ASSOCIATION / ORGANISATION
Name of Organisation
Organisation Type
Organisation Website
Postal Address
Address Line 1 Address Line 2 City State / Province / Region ZIP / Postal Code Country
Physical Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Email
Telephone
Please provide mission statement if your organisation is a non-academic organisation.
Max. file size: 64 MB.
DETAILS OF REPRESENTATIVE.
Prefix
Name
First Last
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Email
Telephone
Mobile
Consent
I accept the following:
Electronic Signature Agreement:
By selecting the "I accept" button, you are signing this Agreement electronically. You agree your electronic signature is the legal equivalent of your manual signature on this Agreement. By selecting "I accept" you consent to be legally bound by this Agreement's terms and conditions.
Full Name and Surname of the person completing the form:
First Last
Phone
This field is for validation purposes and should be left unchanged.

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Application for Membership form

Membership fee is for the period 01 January 2023 – 31 December 2023 irrespective of the date of joining.

Membership fee is for the period 01 January 2023 – 31 December 2023 irrespective of the date of joining.

Membership fee is for the period 01 January 2023 – 31 December 2023 irrespective of the date of joining.

DETAILS OF ASSOCIATION / ORGANISATION

DETAILS OF REPRESENTATIVE.