Associate Membership Details

Associate Member Application

Please submit one of these forms for each Associate Member you would like to add.

Name of person or organisation submitting the below data

All reporting regarding membership is at aggregate level. All details and information submitted is strictly confidential.

Title

Name

First

Last

Known As (Nickname)

Gender

Male

Female

Race

Please note that this question is included because we have to report on this, at aggregate level, to government agencies in South Africa

Identity Document Number

Country of Issue of Identity Document

Country of Birth

Employer Organisation

Please select the existing SAMRA Organisation that you are adding associates for.

Current Position

Level

Role

Employment Status Employment Status

Based in City / Town

Based in Country

Mobile Phone

Work Phone

If you are human, leave this field blank.