Membership Application
Name
*
First Name
Last Name
Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
Town/City
Province
Postal Code
Phone Number
*
Please enter a valid phone number.
Please tick one of the boxes
*
Junior Membership R100
Adult Membership R150
Family Membership R200
Corporate Membership
Life Membership R1500
Please use your NAME and MEMBERSHIP PAID as a reference when making payment
CONSENT
*
By submitting this form I agree to be bound by the SPCA Statement of Policy.
POPI CONSENT: I agree to the processing of my above mentioned personal information for the purpose of electronic communication.
Payment made on:
*
-
Month
-
Day
Year
Date
Signature
*
Submit
Should be Empty: