Public Member Application - FIRA - Funeral Industry Reformed Association

Public Membership Application Form

Step 1 of 3

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Account Details
Email*
Password
Enter Password Confirm Password
User Details
Name*
Title First Last
Physical Address*
Street Address Address Line 2 City Province Postal Code
Postal Address*
Same as previous

Street Address Address Line 2 City Province Postal Code
Cell*
Work Tel
Home Tel
Fax

Funeral Parlor Details
Name of preferred funeral parlor
If you do not have a preferred funeral parlor, FIRA can suggest one for you upon completion of your application.
Funeral Parlor Address
Street Address City Province Postal Code
Funeral Parlor Telephone
Funeral Parlor Telephone (Alternative)
Funeral Parlor Email

Agreement and Confirmation
Signature*
Agreement*
I agree to the constitution and membership policy
Consent*
I agree to the membership application policy*
My application shall be dealt with according to the rules and terms and
conditions of FIRA, the information provided by me herein is, to the best of my knowledge, true and correct
and to undertake to the following:
 I acknowledge that I can only qualify for assistance, guidance and/or submit an official complaint on
the prescribed FIRA complaint initial form, AS AN ACTIVE MEMBER of the Association, with my
membership fees paid up to date;
 I undertake to pay the annual membership fees as determined during the Annual General Meetings.
Payment Terms*
I agree that membership would commence on proof of payment.
I understand that in the case of the application being unsuccessful, the application fee will be forfeited.*
Pricing will be determined on review of your application. You will be contacted via email or Whatsapp with the required amount.

Payment to be made to the following account:

Bank: Standard Bank
Account Number: 012710202
Account Name: FIRA
Account Type: Business Current
Branch Code: 051001
Reference: Your Cellphone Number
Send Proof of Payment to: info@fira.org.za
Name
This field is for validation purposes and should be left unchanged.