Membership Complete the below form to become a member First NameLast NameEmail Address *Identity NumberResident Address *District *State/Province *Phone NumberMembership TypeFull membership (main member): R3 700 AnnuallyHalf membership (added as a family member or farm manager, with one full member already registered): R2 350 AnnuallyDateComplete the below debit order formNameResident AddressPhoneMEMBERSHIP AGREEMENTAccount NameBankBranch Name or NumberAccount NumberType Of AccountCurrentChequeSavingsConsent *I/ We request herewith and give permission that my/ our account as mentioned above be debited with the yearly membership fee for Mpumalanga Agriculture ONLY determined by Mpumalanga Agriculture’s annual Congress. My/ our bank account is to be debited on the Day of the Month below. Request for withdrawal on my/ our bank account from Mpumalanga Agriculture will be handled as if signed by me/ us. I/ We understand that the withdrawal made as authorized will be done electronically by ACB-magnetic banking service and I/ We understand that the details of the yearly debit order willreflect on my/ our bank statement.I/ We agree to cover any bank costs about the debit order.This authorization can be canceled by me/ us through a written thirty-day notice.DateDateSigned at and On Send Message
