New Membership – Society for AIDS in Africa(SAA)

Instructions

We are looking forward to receiving your registration.

Please complete the following form carefully. All boxes marked with an asterisk (*) are mandatory fields. You have the option to fill in boxes not marked with an asterisk (*) to provide additional details. The registration can be paid either by credit card or by bank transfer.

If you have any inquiries or questions, please do not hesitate to contact the Partnership Department.

Select An Option

Student $10 Annually

Individual $25 Annually

Corporate / Organisation $150 Annually

Enter Contact Information

Prefix (i.e. Mr. Mrs. Dr.)

First Name

Last Name

Suffix (i.e Jr. Sr. III)

Designations

E-mail

Family NameOganisation Name

Membership Options are incorrect, Please check the selected membership options