Member - Reregistration form Title*: Surname*: Name*: Address1*: Address2: City*: Country*: Postal Code*: Tel (W): Tel(H): Cell: Fax: Email*: Organisation*: Department*: Language*: Area of Specialisation*: Membership Categories* (The society's membership fees are priced per annum) RSA/Africa (Membership only) RSA/Africa (Hardcopy of SALALS Journal) RSA/Africa (Online SALALS Journal) Outside Africa (Hardcopy of SALALS Journal) Outside Africa (Online SALALS Journal) RSA/Africa student (Online SALALS Journal) Membership year*: (Only the year for which you are registering, ex. 2010) Payment information* Electronic payment Cheque Payment date*: Reference used*: *Required field
Title*:
Surname*:
Name*:
Address1*:
Address2:
City*:
Country*:
Postal Code*:
Tel (W):
Tel(H):
Cell:
Fax:
Email*:
Organisation*:
Department*:
Language*:
Area of Specialisation*:
Membership Categories* (The society's membership fees are priced per annum)
(Only the year for which you are registering, ex. 2010)
Payment information*
Electronic payment Cheque
Payment date*:
Reference used*:
*Required field