DTMSI: Application for Patron / Institutional Membership or Recognition Status


Organisation name :
Name of authorised official :
Registration No (if any) :
Business Address :
Postal Address :
Tel No :
Fax No :
Internet address (if any) :
E-mail :
Main Activity :

Fees Required : $300-00USD or 170-00 Pound Sterling (entry and annual)

Motivate your application for affiliation with the society:


Registrations / memberships / Associations (Please state DESCRIPTION and DATE):


Current or previous involvements (Please state DATE, INSTITUTION, ACTIVITY):


*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 form I certify that the above information is correct, and that I am duly authorised by the above organisation to apply for Patron / Institutional Membership/Recognition Status in the Design Technology and Management Society International. BEFORE SUBMITTING, PLEASE PRINT A COPY OF THIS FORM FOR YOUR RECORDS