On-line Application

LERASA Application Form

Organisation

Invalid Input

Job Title

Invalid Input

Title

Invalid Input

Initials

Invalid Input

Surname(*)

Invalid Input

First Name(*)

Invalid Input

Physical Address

Invalid Input

Postal Address

Invalid Input

City/Town

Invalid Input

Postal Code

Invalid Input

Province

Invalid Input

Country

Invalid Input

Email(*)

Invalid Input

Contact Work(*)

Invalid Input

Cell Number(*)

Invalid Input

Fax

Invalid Input

Previous IRASA Member?

YesNo Invalid Input

Category of Membership

Invalid Input

* including trade unions, employer organisations, tertiary institutions

**Student Number
(if Category is full-time Learner)

Invalid Input

**Learning Institution
(if Category is full-time Learner)

Invalid Input

Method of payment

Invalid Input

* Direct deposit into Standard Bank,
Centurion Branch (Branch Code 012645),
Current Account No: 310332826
** Cheques to be made out to LERASA
*** PayNow online payment once you submit

Submit your Application

Join LERASA

LERASA Application Form