APPLICATION FOR ANNUAL SUBSCRIPTION RENEWAL

Please complete ALL fields

Full Name :
Membership No :
Postal Address :
Country :
Tel No :
Fax No :
E-mail :
Organisation Name :
Renewal for :	Membership / Registration Guilds Interest Group
Payment Method (* South African Applicants 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 :	--Please Select-- VISA MASTERCARD OTHER
If Credit Card type is set to "OTHER" please enter :
Expiry Date :	--Please Select-- 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 (Year) --Please Select-- 01 02 03 04 05 06 07 08 09 10 11 12 (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 certify that the above information is correct. BEFORE SUBMITTING, PLEASE PRINT A COPY OF THIS FORM FOR YOUR RECORDS