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MEMBERSHIP REGISTRATION
NEW MEMBER DETAILS
Title (Mr, Mrs, Dr, etc.)
*
First name
*
Surname
*
School name
*
Designation
*
Principal
Deputy Principal
HOD
Type of school
Primary School
High School
District
*
Circuit name
*
School contact number
*
Mobile number
*
E-mail address
*
MEMBERSHIP fees
Please select your preferred method of payment
*
Once-off annual payment of R540.00
Debit order: Twelve monthly payments of R54.00
COST SUMMARY
Additional costs for this registration
Additional costs details
TOTAL COST
All costs are stipulated in South African Rands.
Billing information
School name to be billed
*
Billing contact person
*
Billing person contact number
*
Billing contact person e-mail address
*
Billing address
*
Payment information
Once you have submitted your membership registration form, you will receive an invoice.
Payment details are on the invoice.
Your membership number will be issued once payment has been made. If you have opted to pay via debit order, please make the necessary arrangements with your bank.
POPIA DISCLAIMER
In accordance to the Protection of Personal Information Act. All personal information provided will solely be used for the purpose of this membership.
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to view the XL Millennium Privacy Policy
I have noted the POPIA Disclaimer
*
Delegate type
Delegate
Presenter
LOC
SAPA Executive
SAPA President
Exhibitor
Breakaway speakers
CC/POP/PO Received
Date
dd/mm/yyyy
Invoice amount
Paid to date
Outstanding balance
Membership number
Payment Details
Hidden Notes
Cancellation
*
=
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