New Member: Individual Application Form This form must be completed by any individual working in the EAP field who seeks membership and certification under the existing professional designation categories. This application form replaces the existing membership form and should be accompanied by other relevant documentation (as indicated below). Maintaining industry recognised accreditations can provide numerous benefits, including improved career prospects and enhanced earning power. It is an indisputable fact that certifications are valuable for EA Practitioners and Professionals’ career advancement. Not only can certifications help individuals differentiate themselves in the market place, but they also serve as an indicator to employers that a potential hire has the requisite skills to perform a specific job or service. Thus, many employers support on-going learning and accreditation for their employees to develop a more skilled workforce. Therefore, certification can become a definite predictive criterion for successful job performance. Step 1 of 2 50% Your Email AddressWe link your membership to one email address. Please use the one email address for all membership matters. Email Address*If you receive an error message that your email address has already been used, please do not fill this form in again. Please request the renewal link from Janine at admin@eapasa.co.za A. Personal InformationTitle*MsMrsMrDrProfRevFirst Names*Surname*Chapter of Your Choice*Please select the Chapter of Your Choice, in the province/city that you reside and work. NB: Northern Cape does not have a chapter yetPlease selectEgoli (Johannesburg)Free StateIkhala (East London)Jacaranda (Pretoria/Tshwane)Kwazulu-NatalLimpopoNelson Mandela BayMpumalangaNorthern CapePlatinum (North West)Western CapeCellphone Number*Home TelephoneID Number*Date of Birth* Date Format: DD slash MM slash YYYY Race*Gender*MaleFemaleNationality*Personal Residential Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Personal Postal AddressIf different from the above Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Are you a full time student or employed?StudentEmployedB. StudiesName of Institution*B. EmploymentName of Employer*Current Position*Work TelephoneHave you been found guilty in a disciplinary hearing?*Please selectYesNoIf yes above, please provide detailsC. Professional Registration and MembershipAre you a member of any Statutory Council, Board or Private Entity?Please selectHPCSASACSSPProfessional AssociationOtherNoPlease provide your membership number*If you answered "Other" to the above, please provide the details, as well as your membership number:*D. Career Promotion/AppointmentPlease provide the details including the year in which it took placeE. Professional DevelopmentTraining or Courses Please provide the detailsYear, Institution, Course Particulars, Duration of Training Courses (e.g. 3 days/ 2 weeks etc)F. Educational QualificationsList all relevant qualifications applicable to the EAP FieldH. ExperiencePlease summarise your current and previous experience in relations to the EAP FieldI: Upload DocumentsPlease upload the relevant documentationCertified copy of your ID or Passport*Stamp valid for 3 months Drop files here or Proof of Employment*This can be your Employment Contract; Letter from Employer or Payslip Drop files here or Proof of Enrollment*For your studies Drop files here or Curriculum Vitae* Drop files here or Certified copies of all qualifications* Drop files here or Copy of Statutory Council Registration Drop files here or Certified copies of courses attended Drop files here or Proof of attendance of courses or presentations for CPD Points (20)* Drop files here or J: DeclarationBy submitting the application, you accept and certify that all the information supplied by you is in all respects true and correct and that I remain bound by the EAPA-SA Constitution, Code of Ethics and Standards. Any misrepresentation can nullify this application. The EAPA SA Board reserves the right to accept/reject this application. Processing of your registration/order will commence as soon as we receive your payment. You will be notified within 10 working days whether you have satisfied the criteria for membership/designation. Designations can only be awarded when the designation committee convenes during Board meetings. EAPA-SA reserves the right to confer membership and designations. Declaration*By submitting the application, I accept and certify that all the information supplied by me is in all respects true and correct and that I remain bound by the EAPA-SA Constitution, Code of Ethics and Standards. Any misrepresentation can nullify this application. The EAPA SA Board reserves the right to accept/reject this application. I agree to the terms of the Declaration
