Membership form

Name *

Surname *

Initials *

Title *

Organisation Name *

Sector

The sector of your organisation

Position *

Your position at your organisation

Postal Address *

Telephone

Cellphone

Email

Date of Birth

Please enter dd/mm/yyyy

GWD Branch *

Grade of GWD membership applied for *

If Professional - please provide SACNASP registration number

Field of Practice

Are you a member of the Geological Society of South Africa ? *

Grade of GSSA membership

Are you a member of any other Associated Scientific and Technical Societies ? *

If Other (please specify):

Student Institution (relevant to Student Membership application)

Student membership criteria: "bona fide" student at a recognised institution.

Student Degree

Name of Supervisor

Contact number (Supervisor)

Date of registration

Please enter dd/mm/yyyy

Payment Options

VAT applies ?

Vat number

Name

National Chairperson: Mr Fanus Fourie
Vice-Chairperson: Ms Nicolette Vermaak
National Treasurer: Mr Yazeed van Wyk
National Secretariat: Dr Jaco Nel
National Coordinator: Ms Elanda Schaffner

Please contact this Committee via [email protected]

Membership form

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