Membership Application Form
All prospective members must complete this form in full.
Name
*
First Name
Last Name
ID Number/Passport Number
*
Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
Province
PostalCode
Phone Number
-
Area Code
Phone Number
Are you a member of any co-operative?
Yes
No
If you answered yes on the above, please provide the name of the network of the co-operative.
Membership Type
*
Membership Only
Membership and Share Scheme
I have read and understood the membership share scheme brochure and constitution of ACI-SA.
*
Yes
No
I agree that my information be processed for the assessment of my application and that it be handled in line with the POPI Act.
Yes
No
Signature
Date
-
Month
-
Day
Year
Date
ID Copy or Passport
*
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