General Application form

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* Required information.
Name of organisation: *
Contact person: *
Position: *
Postal address: *
City: *
Post­code: *
Street address:
Cell ­phone:
Tel: *
Fax:
E­mail:
Website:
Facebook page:
TYPE OF ORGANISATION:
Radio station
Print media
Electronic Media
Television
Content Provider
Church
Other
Other Specify
Type of membership
Category A
Category B
Category C
Associate
Honorary
Affiliate
Development
I agree to comply with ACM constitution and its applicable code of ethics *
1 Name of organisation/church that knows you: (Reference):
Contact person:
Position:
Tel:
E­mail:
2 Name of organisation/church that knows you: (Reference):
Contact person:
Position:
Tel:
E­mail: