WHAT DOES IT COST?

Late Payment fee of R30 will be charged after 28 February

Please answer the following questions:
1. What do you, as a prospective member of IMASA, expect from IMASA?

2. What do you have to offer IMASA?

3. Which province do you reside in?
Eastern CapeFree StateGautengKwaZulu NatalLimpopoMpumalangaNorth WestNorthern CapeWestern CapeOther
4. Which municipality do you work at?
Amahlathi Local MunicipalitAmathole District MunicipalityBlue Crane Route Local MunicipalityBuffalo City Metropolitan Municipality Chris Hani District MunicipalityDr Beyers Naudé Local MunicipalityElundini Local MunicipalityEmalahleni Local MunicipalityEngcobo Local MunicipalityEnoch Mgijima Local MunicipalityGreat Kei Local MunicipalityIngquza Hill Local MunicipalityIntsika Yethu Local MunicipalityInxuba Yethemba Local MunicipalityJoe Gqabi District MunicipalityKing Sabata Dalindyebo Local MunicipalityKouga Local MunicipalityKoukamma Local MunicipalityMakana Local MunicipalityMatatiele Local MunicipalityMbhashe Local MunicipalityMbizana Local MunicipalityMhlontlo Local MunicipalityMnquma Local MunicipalityNdlambe Local MunicipalityNelson Mandela Bay Metropolitan MunicipalityNgqushwa Local MunicipalityNtabankulu Local MunicipalityNyandeni Local MunicipalityOR Tambo District MunicipalityPort St Johns Local MunicipalityRaymond Mhlaba Local MunicipalitySakhisizwe Local MunicipalitySarah Baartman District MunicipalitySenqu Local MunicipalitySundays River Valley Local MunicipalityUmzimvubu Local MunicipalityWalter Sisulu Local MunicipalityDihlabeng Local MunicipalityFezile Dabi District MunicipalityKopanong Local MunicipalityLejweleputswa District MunicipalityLetsemeng Local MunicipalityMafube Local MunicipalityMaluti-A-Phofung Local MunicipalityMangaung Metropolitan MunicipalityMantsopa Local MunicipalityMasilonyana Local MunicipalityMatjhabeng Local MunicipalityMetsimaholo Local MunicipalityMohokare Local MunicipalityMoqhaka Local MunicipalityNala Local Municipality,'mNgwathe Local MunicipalityNketoana Local MunicipalityPhumelela Local MunicipalitySetsoto Local MunicipalityThabo Mofutsanyana District MunicipalityTokologo Local MunicipalityTswelopele Local MunicipalityXhariep District MunicipalityCity of Ekurhuleni Metropolitan MunicipalityCity of Johannesburg Metropolitan MunicipalityCity of Tshwane Metropolitan MunicipalityEmfuleni Local MunicipalityLesedi Local MunicipalityMerafong City Local MunicipalityMidvaal Local MunicipalityMogale City Local MunicipalityRand West City Local MunicipalitySedibeng District MunicipalityWest Rand District MunicipalityAbaQulusi Local MunicipalityAlfred Duma Local MunicipalityAmajuba District MunicipalityBig 5 Hlabisa Local MunicipalityCity of uMhlathuze Local MunicipalityDannhauser Local MunicipalityDr Nkosazana Dlamini Zuma Local MunicipalityeDumbe Local Municipality,eMadlangeni Local MunicipalityEndumeni Local MunicipalityeThekwini Metropolitan MunicipalityGreater Kokstad Local MunicipalityHarry Gwala District MunicipalityiLembe District MunicipalityImpendle Local MunicipalityInkosi Langalibalele Local MunicipalityJozini Local MunicipalityKing Cetshwayo District MunicipalityKwaDukuza Local MunicipalityMandeni Local MunicipalityMaphumulo Local MunicipalityMkhambathini Local MunicipalityMpofana Local MunicipalityMsinga Local MunicipalityMsunduzi Local MunicipalityMthonjaneni Local MunicipalityMtubatuba Local MunicipalityNdwedwe Local MunicipalityNewcastle Local MunicipalityNkandla Local MunicipalityNongoma Local MunicipalityNquthu Local MunicipalityOkhahlamba Local MunicipalityRay Nkonyeni Local MunicipalityRichmond Local MunicipalityUbuhlebezwe Local MunicipalityUgu District MunicipalityUlundi Local MunicipalityUmdoni Local MunicipalityuMfolozi Local MunicipalityuMgungundlovu District MunicipalityuMhlabuyalingana Local MunicipalityuMkhanyakude District MunicipalityuMlalazi Local MunicipalityuMngeni Local MunicipalityuMshwathi Local MunicipalityUmuziwabantu Local MunicipalityUmvoti Local MunicipalityuMzimkhulu Local MunicipalityuMzinyathi District MunicipalityUmzumbe Local MunicipalityuPhongolo Local MunicipalityuThukela District MunicipalityZululand District MunicipalityBa-Phalaborwa Local MunicipalityBela-Bela Local MunicipalityBlouberg Local MunicipalityCapricorn District MunicipalityCollins Chabane Local MunicipalityElias Motsoaledi Local MunicipalityEphraim Mogale Local MunicipalityFetakgomo – Greater Tubatse Local MunicipalityGreater Giyani Local MunicipalityGreater Letaba Local MunicipalityGreater Tzaneen Local MunicipalityLepelle-Nkumpi Local MunicipalityLephalale Local MunicipalityMakhado Local MunicipalityMakhuduthamaga Local MunicipalityMaruleng Local MunicipalityModimolle-Mookgophong Local MunicipalityMogalakwena Local MunicipalityMolemole Local MunicipalityMopani District MunicipalityMusina Local MunicipalityPolokwane Local MunicipalitySekhukhune District MunicipalityThabazimbi Local MunicipalityThulamela Local MunicipalityVhembe District MunicipalityWaterberg District MunicipalityBushbuckridge Local MunicipalityChief Albert Luthuli Local MunicipalityCity of Mbombela Local MunicipalityDipaleseng Local MunicipalityDr JS Moroka Local MunicipalityDr Pixley Ka Isaka Seme Local MunicipalityEhlanzeni District MunicipalityEmakhazeni Local MunicipalityEmalahleni Local MunicipalityGert Sibande District MunicipalityGovan Mbeki Local MunicipalityLekwa Local MunicipalityMkhondo Local MunicipalityMsukaligwa Local MunicipalityNkangala District MunicipalityNkomazi Local MunicipalitySteve Tshwete Local MunicipalityThaba Chweu Local MunicipalityThembisile Hani Local MunicipalityVictor Khanye Local MunicipalityBojanala Platinum District MunicipalityCity of Matlosana Local MunicipalityDitsobotla Local MunicipalityDr Kenneth Kaunda District MunicipalityDr Ruth Segomotsi Mompati District MunicipalityGreater Taung Local MunicipalityJB Marks Local MunicipalityKagisano-Molopo Local MunicipalityKgetlengrivier Local MunicipalityLekwa-Teemane Local MunicipalityMadibeng Local MunicipalityMahikeng Local MunicipalityMamusa Local MunicipalityMaquassi Hills Local MunicipalityMoretele Local MunicipalityMoses Kotane Local MunicipalityNaledi Local MunicipalityNgaka Modiri Molema District MunicipalityRamotshere Moiloa Local MunicipalityRatlou Local MunicipalityRustenburg Local MunicipalityTswaing Local Municipality!Kheis Local MunicipalityDawid Kruiper Local MunicipalityDikgatlong Local MunicipalityEmthanjeni Local MunicipalityFrances Baard District MunicipalityGamagara Local MunicipalityGa-Segonyana Local MunicipalityHantam Local MunicipalityJoe Morolong Local MunicipalityJohn Taolo Gaetsewe District MunicipalityKai !Garib Local MunicipalityKamiesberg Local MunicipalityKareeberg Local MunicipalityKaroo Hoogland Local MunicipalityKgatelopele Local MunicipalityKhai-Ma Local MunicipalityMagareng Local MunicipalityNama Khoi Local MunicipalityNamakwa District MunicipalityPhokwane Local MunicipalityPixley Ka Seme District MunicipalityRenosterberg Local MunicipalityRichtersveld Local MunicipalitySiyancuma Local MunicipalitySiyathemba Local MunicipalitySol Plaatje Local MunicipalityThembelihle Local MunicipalityTsantsabane Local MunicipalityUbuntu Local MunicipalityUmsobomvu Local MunicipalityZF Mgcawu District MunicipalityBeaufort West Local MunicipalityBergrivier Local MunicipalityBitou Local MunicipalityBreede Valley Local MunicipalityCape Agulhas Local MunicipalityCape Winelands District MunicipalityCederberg Local MunicipalityCentral Karoo District MunicipalityCity of Cape Town Metropolitan MunicipalityDrakenstein Local MunicipalityEden District MunicipalityGeorge Local MunicipalityHessequa Local MunicipalityKannaland Local MunicipalityKnysna Local MunicipalityLaingsburg Local MunicipalityLangeberg Local MunicipalityMatzikama Local MunicipalityMossel Bay Local MunicipalityOudtshoorn Local MunicipalityOverberg District MunicipalityOverstrand Local MunicipalityPrince Albert Local MunicipalitySaldanha Bay Local MunicipalityStellenbosch Local MunicipalitySwartland Local MunicipalitySwellendam Local MunicipalityTheewaterskloof Local MunicipalityWest Coast District MunicipalityWitzenberg Local Municipality

APPLICATION FOR MEMBERSHIP

MrMrsMsDrProf
Your Surname (required)

Your Full First Names (required)

Address (where you receive your mail)

Code

Province
Eastern CapeFree StateGautengKwaZulu NatalLimpopoMpumalangaNorth WestNorthern CapeWestern CapeOther

Country

Tel (w)

Cell (w)

Your Email (required)

Date of Birth

ID number

Gender
MaleFemale

Race

Academic Qualifications (Certified Proof to be submitted)

Employment Record in Municipal Administration (Certified Proof to be submitted)

Class of Membership Applied For:
ProfessionalStudentFellowAssociateExternalInternational

DECLARATION
I agree to abide by IMASA's Constitution and any code of conduct that may be adopted by it, as amended from time to time.

Signature Date

I attach hereto:
Proof of qualifications and service record

Membership fee: EFT in favour of IMASACopy of deposit slip