2007 Associate Membership Form
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MEDIA INSTITUTE OF SOUTHERN AFRICA (MISA) ZAMBIA ASSOCIATE MEMBERSHIP APPLICATION/RENEWAL FORM K10,000 SECTION ONE: (TO BE COMPLETED BY APPLICANT) Name: ……………………………………………………………………………….…. Job title:………………………………………………………………………………… Employer……………………………………………………………………………….. Postal address: …………………………………………………………………………. Telephone no(s): …………………………………………………………….…………. Fax no(s): ………………………………………………………………………………. E-mail address(es): …………………………………………………………………….. Date:……………………………….. Signature: ……………………… SECTION TWO: (TO BE COMPLETED BY A SECRETARIAT STAFF MEMBER OF THE MEMBERSHIP COMMITTEE) I ………………………………………….. a bonafide paid-up member of MISA Zambia have interviewed the applicant Mr/Ms. ……………………………I recommend/don’t recommend the application. Date: ……………………… Signature: ……………………………………… SECTION THREE: (TO BE SIGNED BY MISA ZAMBIA MEMBERSHIP COMMITTEE CHAIRPERSON) I ………………………………………………… hereby confirm that the MISA Zambia Membership Committee which met on ………………………………….. Approved/rejected Mr./Ms./Dr./ Prof… …………………………. .application for membership of MISA Zambia. He has been given Full/Associate member. FOR OFFICIAL USE ONLY Payment received by: ………………………… Date: …………………………… Receipt number: ……………………………… 1
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Date:……………………………….. Signature: ……………………… recommend/don’t recommend the application. Zambia Membership Committee which met on ………………………………….. Zambia have interviewed the applicant Mr/Ms. ……………………………I Date: ……………………… Signature: ……………………………………… Approved/rejected Mr./Ms./Dr./ Prof… …………………………. .application for 1
Transcript of 2007 Associate Membership Form
MEDIA INSTITUTE OF SOUTHERN AFRICA (MISA) ZAMBIA
ASSOCIATE MEMBERSHIP APPLICATION/RENEWAL FORMK10,000
SECTION ONE: (TO BE COMPLETED BY APPLICANT)
Name: ……………………………………………………………………………….….
Job title:…………………………………………………………………………………
Employer………………………………………………………………………………..
Postal address: ………………………………………………………………………….
Telephone no(s): …………………………………………………………….………….
Fax no(s): ……………………………………………………………………………….
E-mail address(es): ……………………………………………………………………..
Date:……………………………….. Signature: ………………………
SECTION TWO: (TO BE COMPLETED BY A SECRETARIAT STAFF MEMBER OF THE MEMBERSHIP COMMITTEE)
I ………………………………………….. a bonafide paid-up member of MISA
Zambia have interviewed the applicant Mr/Ms. ……………………………I
recommend/don’t recommend the application.
Date: ……………………… Signature: ………………………………………
SECTION THREE: (TO BE SIGNED BY MISA ZAMBIA MEMBERSHIP COMMITTEE CHAIRPERSON)
I ………………………………………………… hereby confirm that the MISA
Zambia Membership Committee which met on …………………………………..
Approved/rejected Mr./Ms./Dr./ Prof… …………………………. .application for
membership of MISA Zambia. He has been given Full/Associate member.
FOR OFFICIAL USE ONLY
Payment received by: ………………………… Date: ……………………………Receipt number: ………………………………
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