Membership Registration Form

All prospective members of MAARIFA CONSULT are required to complete this registration form. Indicate any changes.
NEW MEMBERSHIPRENEWAL

SECTION 1: MEMBER CONTACT INFORMATION

Title

Full Name

Address 1

Address 2

Address 3

Town / City

Website

Main Telephone

Work Telephone

Home Telephone

Mobile Telephone

SECTION 2: MEMBERSHIP TYPE AND PAYMENT DETAILS

Member Type

Payment Method
Bank ChecksBank Deposit

SECTION 3: MEMBER INFORMATION AND SERVICES INTRESTED IN

Would you like to receive MAARIFA Consult membership information?
YesNo

Does your library participate in Interlibrary Loan?
YesNo

Please indicate if you would be willing to serve on a chapter committee.
YesNot at this time

Is there a specific committee you would like to serve on? (Committees include, Events Management, Area Mobiliser)

Permission to use photographic images:
Photographs of MAARIFA CONSULT members may be used in various MAARIFA CONSULT communications include the newsletter and website. Group photographs taken at MAARIFA CONSULT events may be used without identifying individual members. For individual photographs, please indicate your permission for use:

What MAARIFA Consult services are you most interested in?
RepresentationNetworkingCapacity building/trainingAccess to technical information on Grants/Call for proposalsOther (Specify)

Date:

Please upload scanned copy of your payment document:

I accept and Understand Terms and Conditions.