APPLICATION FOR CORPORATE MEMBERSHIP - 
MATURE CANDIDATE ROUTE

Please complete ALL fields.

 
Full Name of Applicant :
Date of Birth :
Identity No.
Residential Address :
Postal Address :
Tel No (H):
Tel No (W):
E-mail :
ROUTE 1:
Proposed proposal topic for thesis/project :
Topic (1):
 
Topic (2):
   
ROUTE 2:
Select Topics from Society List
List No:
First Choice; Topic No:
Second Choice; Topic No:
 
EMPLOYMENT HISTORY
Please state the following for every employer from the beginning of their careers:

• Current employment, employer name, business address, postal code, telephone no, fax no,
e-mail address, your current position, nature of work, level of responsibility, previous positions,
number of years employed, number of years in a position of senior responsibility, number of
subjects reporting to you, number of senior (if any) you are reporting to, position of the person
above.

Years of unemployment must be clearly stated with full indication of activities during that period.
  
TRAINING RECORD
List each particular training as follows:
Date, Credential, Training Course, Institution, Instructor/mentor
  
Name of mentor:
Occupation:
Postal Address:
Tel(H):
Tel(W):
  
Name of employer:
Academic qualifications:
Professional registrations/citations/etc.
  

Payment Method (*South African Applications only):       |      view DTMSI bank account details

Elec. Transfer   Draft    Cheque   Postal Order    Online (using PayPal)
Direct payment into DTMSI bank account*
Credit Card


For Credit Card Payment Only (complete ALL fields):

PLEASE NOTE: credit card details will be               
encrypted before transmitted over the Internet! 		We accept       
Credit card in the name of :
Credit Card Number :
Credit Card Type :
If Credit Card type is set to "OTHER" please enter :
Expiry Date : (Year)

(Month)
CVV Number
(Last 3 digits on back of card) :
Amount :
DTMSI Bank Account Details (Kindly fax a copy of your deposit slip for our convenience):
Bank First National Bank
Account Name Design, Technology and Management Society International
Account Type Current
Branch Code 20013
Account Number 62066368294
OVERSEAS SWIFT FRINZAJJ
Refer to the bank and the DTMSI account details as above
PLEASE ENSURE THAT YOU UNDERSTAND THE FOLLOWING:

DECLARATION BY THE CANDIDATE
By submitting this application, I hereby certify that the above information is correct and that I understand that should my application be successful, the Assessment Committee may request more information or expect to personally interview me. This will take place at a location and date suitable for the DTMSI Assessment Committee.
I will take care of my own travelling costs.

BEFORE SUBMITTING, PLEASE PRINT A COPY OF THIS FORM FOR YOUR RECORDS