BECOME A PSA MEMBER

Signup Date

Month

Day

Year

First Name *

Last Name *

OTHER/FORMER/MAIDEN NAME

Country of Residence *

Address (Optional)

Cell number *

PLEASE INCLUDE YOUR AREA CODE:. EG. (876)999-9999

Home number

Office number

E-Mail *

PROFESSION/OCCUPATION

COMPANY/ORGANISATION

DESIRED AREA/S OF SERVICE:

YEAR GRADUATED/LEFT SCHOOL *

When to contact for membership fees: Annual = JA $1,500.00 or USD $12.50 Lifetime= JA $40,000 or USD $335.00

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