MIPA MEMBERSHIP APPLICATION FORM Name of Organisation * Owner/CEO/Managing Director: * Postal Address: * Code: Province: Town/City Physical Address * Tel: * Website: Company Reg: * Main Representative Name: * Surname * Tel: Cell: * Email * File Upload * PLEASE UPLOAD YOUR COMPANY PROFILE Attach File No Choosen File (Max 3 MB) We undertake to accept all provisions of the association’s memorandum of incorporation, and code of conduct We further acknowledge that we are aware that the monthly subscription of R 4 000 a month, will become due and payable upon receipt of a MIPA Invoice. Submit
