Membership Form

SOUTHERN AFRICAN PROTECTIVE EQUIPMENT
MARKETING ASSOCIATION

Update your SAPEMA membership information or become a member form:

* Mandatory fields

Name of Company *

Postal Address

Postal Code

Physical Address

Telephone Number *

Fax Number

Mobile Number

Email Address *

Website URL

Representatives at SAPEMA:

Name of Chief Executive Officer *

Email of Chief Executive Officer *

Name of representative attending SAPEMA meetings *

Email of representative attending SAPEMA meetings *

Name of person dealing with Annual Membership Invoice *

Email of person dealing with Annual Membership Invoice *

Your application has to be supported by an existing SAPEMA member

Member in Support - Company Name *

Contact Details - Name of Person *

Telephone Number *

Email Address *

Date

Company Information:

No. of Employees

What Year Established:

Does your Company operate:

Inland / Coastal:

Regionally (Yes/No):

Nationally / International:

What percentage of your turnover is derived from Protective Equipment

Do you have branches? Where?

Membership Fees

I hereby commit, should I be granted membership, to abide by the Constitution and By-Laws of SAPEMA.

I understand that there is an annual membership fee payable and undertake to remit this on receipt of Invoice.

Applicant Name *

Designation *

Date:

What Personal Protective Equipment Products do you handle?

NOTE: This information is required for inclusion in the SAPEMA national safety journal so it needs to be complete and accurate.

PPE Products: (select both if applicable)
DistributorManufacturer

Required Documentation

Company Profile (pdf/doc/docx accepted)

Letterhead (pdf/doc/docx accepted)

Company Logo (jpg/jpeg/png/gif/pdf accepted)

Company Registration (pdf/doc/docx accepted)

Motivational Letter (pdf/doc/docx accepted)

Contact person for site visit:

Name

Cell Number

Office Number