AGANG SA MEMBERSHIP FORM

Membership is R20 per year The fastest way to join Agang SA is to fill in a form on your mobile or on a computer that can be found at http://bit.ly/JoinAgangSA. You can sign up other people on the same form on your phone. If you are unable to access that form, please complete all information in the paper form below.

Surname Cell number Province Suburb Gender MALE FEMALE TV Online

First name Email Municipality

How did you hear about Agang SA?

Radio Word of mouth

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Newspaper Volunteer *
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* If signed up by a volunteer please enter cell number What social media do you use? Signature Facebook Twitter

Mxit

PAYMENT OPTIONS once you have completed the form: Payment of R20 is required to complete membership. There are a number of ways you can pay: You can pay online at www.agangsa.org.za/pages/membership-payment You can use the account details below to complete an EFT please use your cell phone number and last name as reference (012 345 6789 / Lastname) You can complete the deposit form below and take it to ABSA bank DEPOSIT DETAILS Date Account Name Account Number Branch Total Deposit Depositors Name Cell Number
Bank stamp

Y Y Y Y M M D D Agang South Africa 9285086416 632005 R20

PLEASE RETURN THE FORM TO: AGANG SA, Unit 9/001, 9th Floor, Braamfontein Centre, 23 Jorissen Street, Braamfontein, 2017, Gauteng PO Box 31817, Braamfontein, 2017 FAX: 011 718 5042 www.agangsa.org.za