Address: ______________________________________________________________

Postal Address: _______________________________________ Postal Code: _____________

Business Telephone: ________________________ Business Fax: _______________________

Home: Telephone: __________________________  Home fax: _________________________

Email Address: ________________________________________________________ 

Education Level (tick highest level achieved)

□        Matric / School Leaving Certificate      □    University Degree    □        Diploma     

If other than matric / school leaving certificate, please supply details of qualifications obtained. 

__________________________________________________________________________

Membership Categories

I am applying to be an: 

□ Associate: Entrepreneur / corporate employee in the field of image consulting or related fields

□ Affiliate: An individual working in an affiliated business (i.e. Photographer, business consultant, dietician, personal trainer)

□ Student: Must be enrolled at an accredited educational institution in preparation for an image or fashion related career. Proof of registration and enrollment are required, and the student status may not exceed two years.

Other professional Organisations to which you belong:

____________________________________________________________________________________________________________

I undertake to adhere to the APISCA Code of Ethics

Signature: ____________________________________________________________________