Student Membership Applications

* Required

Section 1 — Personal details

Title

Surname

First name

Middle name

Date of birth

Student Identification No.

Section 2 — Contact details

Street address

City

Province

Country

Phone (business)

Mobile

Postal address

Email (alternative)

Section 3 — Academic study

Please provide a letter of acceptance from relevant Tertiary Institution.

Program of study

Course of study

Letter of acceptance (required)

Certified ID / Photo ID (required)

Upload a certified valid passport, driver's licence, or similar identification document.

Section 4 — References

One reference must be a lecturer; the other must be a non-relative personal reference.

Reference 1

Name

Organisation

Profession

Position

Mobile

Reference 2

Name

Organisation

Profession

Position

Mobile

Section 6 — Payment process

After you submit, you’ll receive an email to confirm your email address. Once confirmed, our team will review your application. If approved, we will email you payment instructions and your application reference to use for payment if Electronic Payment.

Section 7 — Consents & declaration

I will observe the Act / Rules / Code of Ethics.

I consent to disclosure for verification with third parties.

I declare the information provided is true and correct.

Signature

Please sign in the box below.

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