Membership Application/Renewal

Membership application and renewal for 2012 is now due.

Option 1 (Preferred):	Online membership application / renewal Please complete the fields below to apply for membership / renewal before 31 March 2012. Please attach your proof of payment in the last field (banking details at end of page). Alternatively, a scanned copy of your bank deposit slip or proof of electronic transfer can be sent to saspen@sun.ac.za OR fax a copy to: 086 245 5183.
Option 2:	Hard copy membership application / renewal Download the membership application/renewal form, complete and finalise payment (before 31 March 2012) . Send a scanned copy of the membership application/renewal form AND proof of payment to saspen@sun.ac.za OR fax copies of both to: 086 245 5183 OR send both via post to the SASPEN Secretariat (see postal address below).

SASPEN Secretariat, c/o Division Human Nutrition, PO Box 19063, Tygerberg, 7505

Important: Please inform the SASPEN Secretariat immediately (at saspen@sun.ac.za) if your address or any other particulars change.

*Fields marked with a red square are mandatory*

Type of membership requested: (Required)

Membership Category (see description of categories below) (Required)

Title

Name (Required)

Surname (Required)

Maiden name

(If applicable)

HPCSA Registration Number

Qualifications

Postal Address (Required)

Postal Code (Required)

Telephone Office Hours (Required)

Telephone After Hours

Mobile phone

Fax Number

E-Mail Address (Required)

Profession: (Required)

If Other, Please Specify

Membership of other societies:

If Other, Please Specify

Proof of Payment (Please attach- See fees and banking details below)

Membership categories and fees for 2012:

DESCRIPTION - categories of membership	FEE
FULL SOUTH AFRICAN MEMBER (including the SAJCN)	R 150.00
STUDENT SOUTH AFRICAN MEMBER (full time)* (including the SAJCN)	Free
INTERNATIONAL MEMBER	USD 25.00

*The SASPEN secretariat will ask you for proof of student registration after membership application.

Banking details:

Please pay the fee into the following account:
Account name
Bank
Branch name
Branch code
Account number

SASPEN
Nedbank
Tyger Valley
103910
1039 030858

Please note that membership will only be activated once proof of payment is received (as applicable).