APPLICATION FORM
APPLICATION FORM
Title (Mr/Mrs/Ms) ___________ Surname: ________________________ Member Number: _________
Given Names: _________________________________________________________________________
Residential Address: ____________________________________________________________________
______________________________________________________________________________________
Home Telephone: ________________ Sex (M/F): ______ Date of Birth: ________________________
Department before retirement: ________________________________ Section: ___________________
Being eligible for membership under the Constitution and Rules of the Public Service Association of SA Inc., I hereby apply to join the said Association as an Associate Member and agree to be bound by and comply with its Rules.
Further, I undertake to inform the Association
of any change of address.
Do you require a PSA Ambassador Card? Yes/No
I enclose herewith subscription fees payable by Cash/Cheque/Credit Card
Credit Card details: Visa card/Bankcard/Mastercard
(delete as required)
Card Number __________/______________/________________ Expiry Date: _____/______
Signature:
____________________________________________ Date: ___/____/____
The PSA/CPSU is bound by the Privacy Amendment (Private Sector) Act 2000. Information is collected to enable the union to contact you about matters related to your union membership and to ensure that we have the necessary information to represent your employment and related interests. A member can opt out of receiving such information by contacting the PSA/CPSU. The PSA/CPSU Privacy Statement is available here or by contacting the office.
___________________________________________________________________________________
Administration Use Only
Date of acceptance: ____/____/_____
Receipt Number: ________________
Accepted
by: ____________________