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Personal Details

Title *

Initials *

First Names *

Surname *

Preferred Name

ID Number *

DOB & Gender auto-filled from ID

Date of Birth *

Gender

Determined from ID number

Race (For EE Purposes)

Marital Status

Home Language

No. of Dependants

Contact Details

Cell Number *

Email Address *

Home Telephone

Work Telephone

Physical Address *

Postal Address

Employment Details

Name of Employer *

Branch / Town *

Occupation *

Employee / Clock Number

Date of Employment

MISA Region *

Declaration & Consent

I, the undersigned, hereby apply for membership to the Motor Industry Staff Association (MISA). I authorise my employer to deduct my union subscriptions from my salary and remit them to MISA in accordance with the provisions of the Labour Relations Act, 1995. I agree to abide by the MISA Constitution.

I, the undersigned, hereby apply for Affiliate membership to the Motor Industry Staff Association (MISA). I agree to abide by the MISA Constitution and to pay the required membership fees directly as an affiliate member.

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