Untitled Document

Application for
Membership

Application for Membership

Membership Registration Form

Title:
Initials:
Preferred Name:
Surname:
Identity Number:
Postal Address:
Postal Code:
Country:
Telephone (w):
Fax:
Cellphone:
Telephone (h):
Email Address:
Employer:
Position:
Highest Qualification:
If "Other" please specify:
HPCSA Number:
Student Number:
Institution:
May PAI make your contact details available to other PAI members?
Research: Please indicate whether you and your organisation will be interested in participating in and/or receiving research information
Participating in a research project by providing a sample Participating in a research project in collaboration with other organisations Providing existing research data to the database Receiving existing research Other - Please specify
A member of the PAI executive will be contacting you to verify your details and request. Please note that this is for your protection. We will let you have the PAI's deposit details once we have confirmed your details with you. If you have any queries please do not hesitate to contact us.

The following document is in pdf format. If you do not have the Adobe Acrobat Reader, you can download it from the following site for free:

http://www.adobe.co.uk/products/acrobat/readstep.html

To download a printable version of this form, please click here

Kindly post the printed form to:
People Assessment in Industry c/o SIOPSA
P.O.Box 1067
Garsfontein
0042

Or fax the form to:
+27 (0)86 514 1946