Associate Membership application # 2.13.8.3
January 2012
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Associate Membership application # 2.13.8.3
January 2012
Page 1 of 4
ASSOCIATE MEMBERSHIP APPLICATION
Associate Membership application # 2.13.8.3
January 2012
Page 1 of 4
PLEASE READ THE FOLLOWING:
Associate Membership may be awarded to any organisation or company established for gain that has an interest in being associated with Zoological Gardens and Aquaria
A pre-requisite of being an Associate Member is that the organization is legally constituted, licensed and registered according to the prevailing legislation of the country/province, although this fact does not automatically guarantee PAAZAB Associate membership.
Note that Associate applications require that the applicant supply the names of two contactable referees. One of these MUST be a member of PAAZAB in good standing. This is a mandatory requirement.
All questions in this document are important in the membership application process. Please answer them as fully as you can and provide all requested documentation. The Executive Office of PAAZAB will consider the application and inform the applicant in due course.
Certain Associate Member Applicants (i.e. Breeding operations/Game farms and/or nature reserves) may be subject to a physical site inspection by representatives of PAAZAB at the discretion of the Executive Committee of PAAZAB. Such inspection visits including travel and accommodation of the inspection team will be to the cost of the applicant.
Associate Membership application # 2.13.8.3
January 2012
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Associate Membership application # 2.13.8.3
January 2012
Page 1 of 4
An application fee of ZAR 2420 (US$350) must accompany this application; this fee is non-refundable.
If PAAZAB Associate membership is awarded, the annual membership fee
(currently ZAR 2420/S$350) will immediately fall due.
Associate Membership application # 2.13.8.3
January 2012
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BANKING DETAILS:
Bank: ABSA
Branch: George, South Africa
Account no: 4055325106
Account holder: PAAZAB
Swift:ABSAZAJJCPE
Bank address:106 York Street
GEORGE
6529
South Africa
Associate Membership application # 2.13.8.3
January 2012
Page 1 of 4
When banking by transfer, please provide full details of your name, facility and reason for deposit
Return the completed form together with the necessary documentation to:
The Executive Director
PAAZAB
P O Box 754
PRETORIA
0001
SOUTH AFRICA
Email:
Please note that the Executive Committee of PAAZAB reserves the discretion to adjust any applicant or member’s category of membership at any time.
TO BE COMPLETED BY ASSOCIATE APPLICANTS
Country______
Province ______
City ______
Name of facility: ______
Nature of Facility:______
Physical address: ______
______
Mailing address (if different):______
______
Telephone, Cell phone, fax and e-mail address (please include country and regional code where applicable).
______
______
Website Address:______
Name of Chief Executive Officer (Please attach a CV) ______
Name of Deputy CEO (Please attach a CV) ______
Year organisation was founded: ______
Name of governing body/corporation; ______
Please attach copies of all operational documentation that legally authorises the existence/operation of the organisation in terms of the prevailing legislation of the country/province.
Please attach a brief description of the nature of your organisation, its principal activities and its association to zoos/aquaria
Please provide a short motivation as to the reasons why you wish your organisation to become an associate member of PAAZAB
Please give the name and address of
two CONTACTABLE referees- one of whom must be a member of PAAZAB in good standing:
Name of Referee______
Contact Details: ______
Name of referee ______
Contact Details:______
DECLARATION
(To be completed by all applicants)
I, ______do hereby declare to agree:
a) to accept and support the philosophy, aims and objectives governing the establishment of Zoos and Aquaria;
b) to accept the value of "ex-situ" conservation of wild species;
c) that Zoos and Aquaria play a role in species conservation;
d) that Zoos and Aquaria are important contributions to scientific knowledge;
e) that Zoos and Aquaria greatly increase public and political awareness;
f) to participate fully in the activities of the Association.
Further, I agree to abide by the Constitution of the Association and its Code of Ethics, copies of which I have received and read.
Please find payment in the sum of R (US$)______to cover myAssociate membership application.
Signed at ______
on this day of ______(Date).
______
Signature of Applicant
Witnesses:
1. ______
2. ______