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?

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