MEMBERSHIP APPLICATION FORM Please fill in the form below. Alternatively you may download the application form here. Please send your completed application form to info@agda.org.za. Please enable JavaScript in your browser to complete this form.Name of organisation *VAT NumberEmail *EmailConfirm EmailAddress *Province *Telephone Number *District *Name of contact person *Year of first AGDA membership *Type of agricultural organisation *Commercial farmerSmall scale farmerCorporate entityIndividual personCooperative / Co-opCommodity OrganisationAgri-organisationFinancial institutionFinancial servicesLegal servicesConstruction servicesOther (please specify below)Other type of organisationProvince(s) operating in *District(s) operating in *PLEASE TICK THE BOXES BELOW TO INDICATE YOUR AGREEMENT WITH THESE BASIC TERMS OF ENGAGEMENT: *I understand that by providing the information above I agree to AGDA using the provided information in their operations, and that such information will be utilised in line with the South African Protection of Personal Information Act (POPI Act).PLEASE TICK THE BOXES BELOW TO INDICATE YOUR AGREEMENT WITH THESE BASIC TERMS OF ENGAGEMENT: *I agree to and hereby give permission for AGDA to generate, utilise and store any audio-visual or other materials or footage including my organisation that may be applicable to the operations and functionality of AGDA.Category of membership (please indicate most applicable option) - (Type of member - Description - Monetary Contribution)Corporate Level 1 - Turnover < R100m - R200 000Corporate Level 2 - Turnover < R50m - R100 000Corporate Level 3 - Turnover < R25m - R75 000Corporate Level 4 - Turnover < R10m - R50 000Platinum - Turnover < R5m - R40 000 Gold - Turnover R6m to R8m - R20 000Silver - Turnover R4m to R6m - R10 000Bronze - Turnover R2m to R4m - R5 000Ordinary members - Turnover R1m to R2m - R2 500Associate members Level 1 - Turnover R750 000 to R1m - R450Associate members Level 2 - Turnover R500 000 to R749 000 - R300Associate members Level 3 - Turnover R250 000 to R499 000 - R150Association members (Co-ops, Commodity Organisations, Agri-organisations, etc)Level 1 - More than 1000 members - R25 000Level 2 - Between 500 and 999 members - R12 500Level 3 - Less than 500 members - R6 250If you are a farmer, which category to you represent - Small/Medium/LargeWhat commodities do you specialise in?Do you have access to markets?Any other information that you think may be helpfulWhich province do you farm in?GautengEastern CapeFree StateLimpopoKwaZulu NatalMpumalangaNorthern CapeNorth WestWestern CapeIf you are a Commodity Organisation/Agri-business, which parts of the country do you work in?GautengEastern CapeFree StateLimpopoKwaZulu NatalMpumalangaNorthern CapeNorth WestWestern CapeAny other information that you think may be usefulIf you are part of another sector, which sector do you represent eg. Financial services, Legal, Construction etc.Nature and type of businessWhich part of the country to you have a footprint in?GautengEastern CapeFree StateLimpopoKwaZulu NatalMpumalangaNorthern CapeNorth WestWestern CapeAny other information that you think may be useful Submit