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WESSALife
Membership Registration
Membership Type
Member Details
Postal Address
Group Membership
Change Details
Friends Groups, Conservancies & Affiliates R450p/year
*New Membership or Renewal
New
Renewal
*Membership Number (if existing member)
*Name in which membership is held
*First Name
*Last Name
*Email
Title
Phone
Position, if group, company, school, organisation, institution
*Date of Birth or Date Formed (if group, company or organisation)
VAT registration number if a company
*Entity
Individual
Group
Company
School
Orginisation
Institution
Work Skills & Interest if an Individual or
Details of Operation If group, company or organisation
*Country
Select
South Africa
Unit / Box / Street
Suburb / Town
City / District
*Province
*Postcode / ZIP
VAT registration number if a company
Payment Method
Card
EFT
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