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Safe Abortion Alliance of Southern Africa (SAASA) Membership Form

1. Are you an Individual or an organisation? *This question is required.

Name of organisation *This question is required.

2. organisational role

3. Contact person *This question is required.

4. Cellphone number *This question is required. This question requires a valid number format.

5. Email address *This question is required. This question requires a valid email address.

6. Website

How do you identify? *This question is required.

Please enter an 'other' value for this selection. * This question is required.

7. Complete the following demographic info *This question is required.

Province

District

8. Social Media Id *This question is required.

X
Facebook
Instagram
Linked In
Other

9. How did you hear about SAASA? *This question is required.

Meeting
GL website
Via a call
Other: Specify Please enter an 'other' value for this selection.

10. What do you hope to contribute to SAASA? *This question is required.

11. What do you hope to gain from SAASA? *This question is required.

12. Do you give permission for you or your organisation to be listed as a SAASA member on the website? *This question is required.