iLGM - Membership Application Form

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Membership Application Form

Select Membership Type Applied for:

Membership Type - Full Membership - (for Municipal Members)
Affiliate Membership - (For Companies and Organisations)
Student Membership
Special Category Membership

Please select the membership class that you want apply for.

Corporate Information

Company or Organisation Name *

Name of your company or organisation as you want it to appear on invoices.

VAT Number

Name and Address Particulars

Title, First Name and Last Name *

Postal Address *

eMail Address *

Mobile Phone Number *

Office Phone Number

Employment and Qualifications

Name of your Employer Organisation

Your position in Organisation *

Highest Academic Qualification *

Students Section

Educational Institution Name

Qualification that you are working on

When will you complete current studies

Payment Options

I want to - * Pay by bank transferPay by annual debit order

Debit Order

Account Holder Name

Bank Name

Account Number

Branch Code

When paying by annual debit order, the institute will transfer from your account every year around June the amount of your annual subscritpion fee as authorised by the national executive committee.

If you wish to cancel a debit order please contact the secretariat on 011 789-1384

Bank Transfer Details

Date that transfer was done on *

Amount that was Transfered *

Please use your first and last name as reference when transfering funds to the iLGM.

NOTES:

PLEASE REMEMBER TO FAX A COPY OF YOUR

A) ACADEMIC QUALIFICATIONS CERTIFICATES

B) SUPPORTING LETTER FROM THE PERSON THAT YOU REPORT TO

TO THE SECRETARIAT 011 789-1385

THE APPLICATION CAN NOT BE PROCESSED WITHOUT THE REQUIRED CERTIFICATES AND SUPPORTING NOTE, LETTER OR EMAIL FROM YOUR SUPERIOR.

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