Afrostain Media Corporate Membership Application Form

Thank you for confirming your membership to the Afrostain Media. We continue to be
committed to upholding and enhancing our Digital Marketing Standards Globally.

Complete the form in block letters

An application form must be completed when:

• Applying for membership for the first time and or updating information.

For office use only

Date entered: ……. /…../……………. Member no ……………………………

COMPANY DETAILS

Name of organization:

Company Physical Address:

Name of Contact Person

Designation
Contact Details of Contact Person:
Email ……………………………………………………………………………..

Telephone …………………………………............................

Cell: ………………………………………………………………………………

How did you come to

know about Afrostain
Media

In what areas would you want Afrostain Media to assist you and your company in your
business development?
 1…………………………………………………………………………………………......

2…………………………………………………………………………………………….

WHICH INDUSTRY GROUPS DOES YOUR ORGANISATION BELONG?

ICT TRANSPORT & MOTOR INDUSTRY

TRAVEL & TOURISM/HOSPITALITY HEALTHCARE & PHAMACEUTICAL

RETAIL MANUFACTURING INDUSTRY

FINANCIAL SERVICES CLOTHING MANUFACTURING

CONSTRUCTION AND REAL ESTATE AGRO-BUSINESS

MEDIA SPORT AND RECREATION

FROM TOPICS LISTED BELOW, WHICH ONES WOULD YOUR COMPANY WANT TO RECEIVE
INVITATIONS TO TALKS/TRAINING COURSES & SEMINARS

CORPORATE GOVERNANCE MARKETING RESEARCH

PUBLIC SECTOR MARKEKTING LEGAL ISSUES IN MARKETING

SERVICES MARKETING ADVERTISING

KEY ACCOUNT MANAGEMENT

INTERNATIONAL TRADE SALES/SALES MANAGEMENT

SME MARKETING RELATIONSHIP MARKETING

OTHER (SPECIFY)

Membership level Taken (Tick Applicable)

Platinum (US$650.00 pa) Gold (US$550.00 pa) Silver (US$350.00 pa)

DECLARATION

Please read the following carefully before signing the form:

• We hereby apply for the membership of the Afrostain Media and, if accepted, we
agree to abide by the rules and regulations as set out in the constitution and by-laws.
• We undertake to pay our Afrostain Media membership fees on the due date. If we
withdraw our membership, we will give three months notice in writing stating our
reasons, and immediately pay all monies owing.

Date: ……………………… Signature: ……………………………………….

(Of company representative)
3) PAYMENT DETAILS

CASH TRANSFER

TRANSFER DETAILS:
Account name: Afrostain Farmtech
Bank: BancABC
Account number: 125-53865875502012
Branch: Heritage

Contact us on:
Afrostain Farmtech
Cnr First and Nelson Mandela
Nicoz House, Second Floor
Harare Zimbabwe

Tel; +2638644297729
Cell: +263712689214
Email: media@afrostain.co.zw