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I hereby apply for membership of UASA. I undertake to abide by the Constitution of UASA at all times and realise that all the services and benefits linked to my specific membership option are subject to the terms and conditions that may be decided upon by the National Executive Committee from time to time. I do also understand that my membership will lapse after (1) month of nonpayment of my subscriptions.

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Names and Birth Dates of Spouse and Children

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Bank Debit Order


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