GEOLOGICAL SOCIETY OF SOUTH AFRICA
Western Cape Branch
Postal Address: Andrea Baker
Membership, GSSA Western Cape Branch
Department of Earth Science, Kamer van Mynwese building
Stellenbosch University, Stellenbosch, 7600
Tel: 072 100 8173
Email: [email protected]
2015 MEMBERSHIP REGISTRATION DETAILS
Please use this form if you are applying for new membership of the society or for updating of your
details for the society’s membership database. * indicates a required field.
*First Name:……………………………….…… Last name: ...................................
Title:.……..…
*Nationality ……………………………………
Company/Organisation:………………………………….…… Position:………………….……………
*Physical Address: ……………………………………………………………………………………….
(where you live locally) ………………………………………………………………..………………....
……………………………………………………………………………………………………………..…
Postal Address:…………………………………………………………………………………………..…
(If different from above)………………………………………………………………………..………….
Home Telephone No: ………………………………………………
Work Telephone No : ………………………………………………
*Cellphone Number: …………………………………………………
*Email: ………………………………………………………………………………………………………..
The Branch will communicate with members only by email except in exceptional circumstances:
However we need a cell phone or telephone number for emergency contact.
*Are you a member of the mother society (The Geological Society of South Africa)?: Yes
No
I hereby apply for membership in the Western Cape Branch of the Geological Society of
South Africa.
Date ………………………….
Signature ……………………………….………………………..
Please send to the Branch Secretary, Saranne, by Post, Fax or email, to the address above, or hand in at
one of the society’s meetings. If you have already paid fees, please mark the appropriate membership type
‘Paid ‘ and the date, and how paid
Ordinary or Associate member
Student member
(R100.00): ..…............................ Please tick this box if
(R50.00): ………....................... you require a receipt:
(Ordinary Members are also members of the Mother Society (The Geological Society of South Africa) :
Student members are full time students at a university or high school)
Note: Fees may be paid by cash to a committee member, or by interbank transfer into the Branch account
(Preferred method - details below) or by cheque made out to Western Cape Branch - GSSA: Please do
not deposit cash into the account as it incurs a heavy transaction fee
Banking Details for EFT payment:
NB: Please put your name + ‘fees’ as a
reference and email a
confirmation to address listed above
Bank: ABSA:
Account Name Western Cape Branch - GSSA
Account Number 9228098068
Absa Bank do not require a branch number