User login

Navigation

COPE Membership Form

Print this page.

COPE New Membership

Currently COPE is offering the following membership options:

COPE Member (contribute at least R 30.00 to be eligible for this membership)

Contribution Amount *	R 30.00 COPE Anual Membership Only R 130.00 COPE Anual Membership + Donation Other Amount
Other Amount	R
	`[x]` I will send payment by check or EFT
Email Address *

COPE Membership Form

First Name *
Last Name *
Gender *	Female Male
Birth Date
ID Number *
Street Address (Residential) *
City (Residential) *
Postal Code (Residential) *
Country *
Province *
Region *
Phone (Home)
Phone (Work)
Cell Phone *
Are you registered to vote? *	Yes No
If so, in what ward?
I Accept The Declaration of Membership *	Yes No Declaration of Membership: I solemnly declare that I will abide by the constitution and policies as agreed to by the organisation at its conference. I will respect the Constitution of the Republic of South Africa and all laws of the country. I will strive for a non-racial, non-sexist and democratic South Africa where all people shall enjoy equal rights, opportunities and prosperity.

Theme provided by Acquia, Inc. under GPL license from TopNotchThemes Drupal themes