Member Registration for Organisations
Note: The information given in this form will be kept strictly confidential
Contact Person Details
Title
Mr.
Ms.
Mrs.
Dr.
Prof.
*
First Name
*
Last Name
*
Company
*
Job Title
*
Email
*
Mobile Phone
Organisation Infomation
*
Organisation Name
Trading name (if different)
Year Started
VAT Number
*
Webpage URL
*
Type of Organisation
Business Trust
Close Corporation
Other
Partnership
Private Company
Public Company
Section 21 (Non-Profit)
Sole Proprietor
*
Business Telephone Number
Fax Number
*
Business Street Address
*
City
*
Province
*
Country
*
Postal Code
*
Cape Town Suburb
Cape Flats
City Bowl & Atlantic Seaboard
Northern Suburbs
Southern Suburbs
South Peninsula
Winelands
Greater Cape Town
*
BBBEE Level
Level 1
Level 2
Level 3
Level 4
Level 5
Level 6
Level 7
Level 8
Non compliant
Percentage of Female ownership
100 %
91 - 99 %
51 - 90 %
20 - 50 %
below 19 %
*
Description of business activities
*
Type of Membership
Business with less than 9 staff
Business with between 10 and 49 staff
Business with more than 50 staff
Academic organisation
PGWC and City of Cape Town
CITi sponsors and funders
Non profit organisation
Please complete as much information as possible about your organisation. Please ensure you are the correct person to complete this form and are authorised to submit the application on behalf of your organisation
*
Does your organisation currently export its products / services?
Yes
No
I don't know
*
Does your organisation plan to export its products / services in 2012?
Yes
No
I don't know
*
Does your organisation have a valid BBBEE scorecard or certificate?
Yes
No
I don't know
*
Does your organisation plan to get a BBBEE scorecard / certificate in 2012?
Yes
No
I don't know
*
Annual turnover for last financial year:
R0 - Still pre-revenue
R1 - R500 000
R500 001 - R1 million
R1 000 001 - R2 million
R2 000 001 - R5 million
R5 000 001 - R10 million
R10 000 001 - R20 million
R20 000 001 - R35 million
More than R35 million
*
Total number of employees in the Western Cape:
EMPLOYEE COUNT
(Please complete as far as possible)
Number of Employees
Full-time:
Part-time:
Female:
PDI
Other
Total no. disabled:
*
Does your organisation also employ people outside the Western Cape?
Yes
No
*
Has your organisation been a CITI member in the past?
Yes
No
I don't know
*
Is your organisation currently a tenant of the Bandwidth Barn?
Yes
No
If no, has your organisation ever been a tenant of the Bandwidth Barn?
Yes
No
I don't know
Has any staff member of your organisation ever participated in any Bandwidth Barn programme (e.g. VeloCITI, My Mentor or Accel programmes)?
Yes
No
I don't know
If yes, which programme and when?
MEMBERSHIP FEES FOR 2011
Membership fees for Feb 2011 - Jan 2012
Membership type
Cost per year (incl VAT)
•Business with less than 9 staff
Free
•Business with between 10 and 49 staff
Free
•Business with more than 50 staff
Free
•Academic organisation
Free
•PGWC and City of Cape Town
Free
•CITI sponsors and funders
Free
•Non-profit organisations
Free
MEMBERSHIP APPLICATION
By submitting this application, you commit and agree to all of the terms and conditions of CITI membership listed below:
1. COMMITMENT
Management and staff of the applicant organisation commit that they will support the aims and objectives of the Cape IT Initiative (this being "to develop and support the ICT cluster in the Western Cape.")
2. USE OF CITI LOGO
Management and staff of the applicant organisation will obtain prior written approval from CITI for any use of the CITI logo.
3. BENEFITS
CITI reserves the right to change the nature of the benefits it offers to members.
4. CANCELLATION
CITI reserves the right to cancel any member's subscription at any time.
5. DURATION OF MEMBERSHIP
Membership duration is one year (Feb 2011 to Jan 2012). Membership duration for members who join after 31 August 2011 is 6 months.
By clicking on the "Submit" button below, you certify that you are authorised to submit this form on behalf of your organisation and that the information supplied on this application is correct and that you agree to abide by all the terms and and conditions of membership as stated above.
*
Indicates Response Required
Cape Information Technology initiative
125 Buitengracht Street, Cape Town, 8001
T +27 21 409 7000
, F +27 21 409 7050
www.citi.org.za