New Member Application

South Africa Chapter of Application- *

First Name *

Last Name *

Phone Number *

email address *

Street Address 1 *

City *

Province *

Postal code *

Postal Address-

Company / Business Name *

Company Registration #:

Business Category *

Website

Does your profession require special licensing? *

Does your profession require special certifications? *

Does your profession require any special accreditations? *

If yes to any, please explain or describe here:

Has your professional license ever been revoked or suspended? (If yes, please provide full details) *

If yes, please provide full details-

Have you ever been convicted of a felony? (If yes, please provide details) *

If yes, please provide details-

Brief description of your business: *

Position in relationship to business *

Years in business *

Number of employees, excluding yourself? *

Business Physical Address? *

Have you ever been a member of any other referral networking organization? *

If yes, which organization and dates you were a member?

Is this your primary business? *

Membership will be funded by whom? *

Who referred you to TEAM? *

Name Badge - First & Last Name *

Name Badge - Business Name or Category *

I am transferring from another CHAPTER (already a member). *

New Membership Payment Information (payment link will be sent separately upon chapter approval)

1 year membership - R7 500 plus a R500 once off enrollment fee = R8 000

2 years membership - R13 050 plus a R500 once off enrollment fee = R13 550

PAYMENTS COLLECTED ARE NON-REFUNDABLE

Please provide us with two business references below:

Please include- Name and Surname, Position, Business Name, Contact Number,

E-mail address, Business relationship to yourself. Also please notify them that you've given us their information and that it will not be used for anything other than the intended purpose.

Business reference #1- *

Business reference #2- *

Click below to view TEAM Policies & Procedures:

Please check (Required for application submission):

I have read, understand and agree to all policies and procedures of TEAM Referral Network Corporation. I do agree to hold TEAM Referral Network, TEAM Franchise Corp, its franchisees, Directorates, contracted agents and affiliates harmless of any and all liabilities that may arise as a function of my membership as a TEAM Referral Network member and understand the TEAM Referral Network is an "at will" organization. * *