MEMBERSHIP APPLICATION FORM

Please complete the application form below to apply for WiBA Membership

PERSONAL INFORMATION

First Name

Last Name

Email Address

Cell number

BUSINESS INFORMATION - section 1

Company Name

Your Role/Position

Brief Description of Business

Years in current position

BILLING INFORMATION

VAT Number (if applicable)

Billing Address

Billing Address Line 2

City

Postal / Zip code

Region/State/Province

DECLARATION

We use Whatsapp to communicate with our members. I hereby give permission to be contacted on Whatsapp using the cellphone number I provided in this application.

I declare that the information above is true and correct.

I understand that I have signed up for a 12 month membership billed according to my selected preference (annually, quarterly, monthly).

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