New VPASA Membership Form

NEW MEMBERSHIP APPLICATION

R 350

Monthly

No voting rights at AGM
Attend 1 VPASA event annually free (1 ticket per event)
Monthly newsletter and other industry updates

R 1000

Monthly

No voting rights at AGM
Attend 1 VPASA event annually free (1 ticket per event)
Monthly newsletter and other industry updates
Third preference for event partnerships with VPASA

R 3000

Monthly

No voting rights at AGM
Invitation to attend meetings with regulators
Attend up to 2 VPASA events annually free (1 ticket per event)
Monthly newsletter and other industry updates
Second preference for event partnerships with VPASA
Publish copany specific news twice a year on VPASA website & newsletter

R 5000

Monthly

1 Vote at AGM
Invitation to attend meetings with regulators
Attend up to 3 VPASA events annually free (1 ticket per event)
Monthly newsletter and other industry updates
First preference for event partnerships with VPASA
Publish company specific news twice a year on VPASA website & newsletter
Display of Logo on VPASA Collateral such as fliers and pamphlets
Speaking opportunities at VPASA organised conferences and media engagements

Please Select the Membership Tier you will be applying for

COMPANY DETAILS

Registered Name of the Organisation

Trading Name

Holding Company Name (if applicable)

Organisation Registration Number

Country of Registration

Contact Person First Name

Contact Person Last Name

Date Established

Date Registered

Core Business of the Organisation

COMPANY ADDRESS DETAILS

Postal Address

Postal: Street Name / Box Number

Postal Suburb

Postal City

Postal Code

Physical / Delivery Address

Delivery Street Name

Delivery Suburb

Delivery City

Delivery Province

Delivery Code

DEFINITION OF AUTHORISED REPRESENTATIVE

The authorised representative is the person authorised by the organisation to transact with VPASA on behalf of the organisation

Authorised Title

Authorised First Name

Authorised Last Name

Authorised Preferred Name

Authorised Identity Number

Authorised Date of Birth

Authorised Gender

Authorised Email Address

Authorised Telephone Number

Authorised Mobile Number

Authorised Country Of Residence

Authorised Nationality

Authorised Province / State

Authorised Department

Authorised Current Position

Authorised Date appointed in current position

BILLING INFORMATION

Billing Contact Title

Billing Contact First Name

Billing Contact Last Name

Billing Contact Current Position

Billing Contact Email Address

Billing Contact Work Phone Number

Billing Contact Mobile Number

Billing Contact Fax Number

Prefered Invoice Currency

Is a Order Number Required For Billing Purposes

YES - Order Number Required NO - Order Number Required

VAT Number

I hereby certify that: (Please indicate agreement by ticking the relevant boxes)

The information set out in this submission is true and correct to the best of my knowledge.

The above organisation abides by the Vapour Products Association of South Africa (VPA), and Code of Conduct.

I undertake, on behalf of the above organisation, to ensure payment of any fees due to VPA.

I understand that the organisation will remain a member of VPA until such time as a valid resignation is submitted to and received by VPA, or membership is withdrawn by VPA.

The above organisation meets the criteria for VPA Membership.

Fellowship Membership

Affiliate Membership

Associate Membership

Full Membership

COMPANY DETAILS

COMPANY ADDRESS DETAILS

Postal Address

Physical / Delivery Address

DEFINITION OF AUTHORISED REPRESENTATIVE

BILLING INFORMATION

I hereby certify that: (Please indicate agreement by ticking the relevant boxes)

Vapour Products Association of South Africa (VPASA)

COVID-19 South African Resource Portal

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Fellowship Membership

Affiliate Membership

Associate Membership

Full Membership

COMPANY DETAILS

COMPANY ADDRESS DETAILS

Postal Address

Physical / Delivery Address

DEFINITION OF AUTHORISED REPRESENTATIVE

BILLING INFORMATION

I hereby certify that: (Please indicate agreement by ticking the relevant boxes)

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Vapour Products Association of South Africa (VPASA)

COVID-19 South African Resource Portal

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