African Wildlife and Environment Issue 72

WESSA MEMBERSHIP ▪ New and renewal membership ▪ Information update ▪ Donations Return information and proof of payment to: Email: membership@wessalife.org.za Fax to email: 086 519 2018 Postal: c/o 100 Brand Road Durban 4001 Phone: 031 303 6099

See also, regional contact details on page 1

EARTH CARER MEMBERSHIP APPLICATION Main contact person if in name of family, company, group, school, organisation or institution

NAME MEMBERSHIP HELD IN MEMBERSHIP OPTION

MEMBERSHIP NUMBER

SURNAME

TITLE

FIRST NAME POSITION if company, group etc. YEAR OF BIRTH if an individual EMAIL LANDLINE CELL POSTAL ADDRESS

POSTAL CODE

NOTES & ADDITIONAL INFORMATION

EXTRA POSTAGE: International & SADC country magazine subscribers add extra postage (per annum) as follows: LEVEL A: INT R745 SADC R485 │ LEVEL B & D: INT R290 SADC R215 │ LEVEL C: I NT R175 SADC R140 SADC COUNTRIES: Angola, Botswana, Burundi, Comoros, Congo (DRC), Congo (Peoples Rep), Gabon, Kenya, Lesotho, Madagascar, Malawi, Mauritius, Mozambique, Namibia, Reunion, Rwanda, Seychelles, Swaziland, Tanzania, Uganda, Zambia and Zimbabwe. BANK ACCOUNT DETAILS Name of Account: WESSA Membership Bank: First National Bank 1. EFT │ DIRECT DEPOSIT: Deposit ref: Initials & Surname + membership number if existing member 2. ONLINE: Go to: www.wessalife.org.za 3. DEBIT OR CREDIT CARD: Complete details below and return. 4. CHEQUE: Cross and make payable to WESSA Donation PAYMENT BY DEBIT OR CREDIT CARD: Visa or MasterCard. Please complete the following and return via email or post Cardholder’s Name Signature Branch & Code: Howick 22-07-25 Account Number: 62 219 969 732 Payment type & amount Payment amount R Renewal New

Card Number CVV Number

Expiry Date All necessary precautions will be taken to ensure compliance with the Protection of Personal Information (POPI) Act 4 of 2013

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