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Apply for Reps SA membership - Step
1
Registration type
Type (Please select the correct option)
<Select Types>
Standard
International Portability
*
Identification type
Type (Please select the correct option)
<Select Identification Type>
RSA ID Document
Valid Passport
*
Personal details
First name
*
Surname
*
Title
<Select Title>
Mr
Mrs
Miss
Ms
Dr
Rev
Sir
Prof
Mev
Mej
Past
Mnr
Ds
*
Birth Date
April 2024
April 2024
S
M
T
W
T
F
S
14
31
1
2
3
4
5
6
15
7
8
9
10
11
12
13
16
14
15
16
17
18
19
20
17
21
22
23
24
25
26
27
18
28
29
30
1
2
3
4
19
5
6
7
8
9
10
11
*
Password
*
Gender
<Select Gender>
Male
Female
*
Repeat Password
*
Passwords Do Not Match!
Contact details
List
<Select List Status>
Yes
No
Email
*
* Invalid Email Address
Tel
Town
*
Province
<Select Province>
Eastern Cape
Free State
Gauteng
KwaZulu-Natal
Limpopo
Mpumalanga
North West
Northern Cape
Outside South Africa
Overseas
Western Cape
*
Postal Address
*
Postal Code
*
Equity
<Select Equality Type>
Black: African
Black: Coloured
Black: Indian/Asian
White
Unknown
Nationality
<Select Nationality>
South Africa
Angola
Botswana
Lesotho
Malawi
Mauritius
Mozambique
Namibia
Seychelles
Swaziland
Tanzania
Zaire
Zambia
Zimbabwe
Asian countries
Australia and Newzeland
European countries
North American countries
Central and South American countries
Other and rest of Oceania
N/A Institution
Rest of Africa
*
Home Language
<Select Language>
Afrikaans
English
isiNdebele
sePedi
seSotho
seTswana
siSwati
South African Sign Language
tshiVenda
isiXhosa
xiTsonga
isiZulu
Other
Unknown
*
Citizen
<Select Citizen Type>
Dual (SA plus Other)
Permanet Resident
South Africa
Other
Unknown
*
Socio Economic
<Select Socio Economic Type>
Employed
Unemployed looking for work
Not working, not looking for work
Not working, housewife / home-maker
Not working, scholar / full-time student
Not working, pensioner / retired person
Not working, disabled person
Not working, not wishing to work
Not working, none of the above
N/A: Aged < 15
N/A: Institution
Unspecified
Self employed
*
Disability Status
<Select Disability Status>
Sight (even with glasses)
Hearing (even with aid)
Communication (talk/listen)
Physical (move/stand etc)
Intellectual (difficulties in learning); retardation
Emotional (behavioural or psychological)
Multiple
Disabled but unspecified
None
None now was - Sight
None now was - Hearing
None now was - Communication
None now was - Physical
None now was - Intellectual
None now was - Emotional
None now was - Multiple
None now was - Disabled but unspecified
*
REPSSA
INVOICE
Postnet Suite 337
Private Bag X1
Jukskei Park, 2153
Invoice #:
Invoice Date:
Membership #:
IN0005010
2015-08-06
MEMNumber
INVOICE TO:
CUSTOMER
Description
Amount:
Annual Subscription Fee to REPSSA
R 700.00
Total:
R 700.00
Account Name:
Account No.:
Bank:
Bank Code:
Reference number:
REPSSA
021 533 695
Standard Bank
018105
Postal business address
REPSSA
Postnet Suite 337
Private Bag X1
Jukskei Park
2153
Gauteng
Telephone number
011 025 77 63
E-mail Address
info@repssa.com