Membership Form Please complete one form per owner. Name of Business: No.: of employees: Name of owner(s): Initials: Name: Surname: Street Address: City: Province: Postal Code: Postal Address: City: Postal Code: Home Language: ID No.: Work Contact No.: Fax No.: Cell No.: E-Mail Address: Please tick (√) the category for your business: SMME Agriculture Franchisee Please indicate number of years in business (e.g. from 1999 to 2009 – 10 years): If family business, please indicate the generation you are currently in. (eg. 1st, 2nd, 3rd): Please tick (√) whether you would like to be a member OR organising member in your region: Member Organising Member (Tick Organising Member if you would like to be actively involved in FABASA in your region regarding managing Family Business Forums) May we share your business information with other FABASA members via our website? Yes No May we display your company logo on the FABASA website for promotional purposes? Yes No Please leave this field empty.