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Application Form

Membership Details:

Full name

(First name,
Middle names, Last name (Surname)

Title
Job Title:
Date of Birth
Postal Address
 
 
City
Postal Code
Province
Office Tel
Cell No:
Home Tel
Fax
 
Employer
Branch
Industry
ID Number
Passport Number
Language
Invoice Address
 
 
City
Postal Code
   
How did you hear about IITPSA?
Email
Website
 
Hierarchical expertise (over the last 10 years):
Position Held Years
Chief Executive Officer
Chief Information Officer
Senior Management - eg: General Manager
Middle Management
Junior management/team leader
Technical
Other: please specify
 
Key Skills experience (over the last 10 years, max 15):
Skill Select
Technical
Marketing
Sales
Communications
Finance
Quality
Programming
Web Programming
Database Development
Network Development
Business Intelligence/Decision Support/Reporting Tools
BCP / DRP
BPM
Call Centers/Computer Telephony Integration
Cellular System & Services
Content Management
CRM
Database Management/Data Warehousing
Desktop Applications
E-commerce Sollutions/Transactions
E-billing
E-learning
E-mail/Messaging/Groupware
Enterprise Application Integration
 
Skill Select
Enterprise Architecture
Enterprise Resource Planning
Identity Management
Information Lifecycle Management
IT Services & Support
Knowledge Management
Networking Hardware & Management
Performance Management
Project Management
Security/VPN
Governance
Data Management
Business Analysis
Open Source
Software Testing
Business Analysis
System Analysis
IT and Project Governance
Business Process Management
Outsourcing
Support
Consultancy
Human Resource
Other: Please specify
 
Key Achievements (over the last 10 years) 40 characters each:
1. 
2. 
3. 
4. 
5. 
 
Indicate which Special Interest Groups, Focus Groups & Seminars maybe of interest to you:
Information Software Testing
Project Management IT
Business Process Management
Information Security
IT & Project Governance
Computer –Human Interaction
Business Analyst & System Analyst
Software in Action
Customer Relations Management
Open Source
 
 
Indicate with which Roles of CSSA/IITPSA you are / were involved (e.g 2006):
Role Start Year End Year
MANCO
Chapter Committee
Past President
SIG Member
EXCO
Other: Please Specify
 
Indicate with which Professional Body/(ies) you are involved:
Association of Computing Machinery (ACM)
Black IT Forum
Black Management Forum (BMF)
Businesswomen·s Association of SA
Computer Users Council of SA
Electronic Industry Federation (EIF)
International Federation for Information Processing (IFIP)
Institute of Electrical & Electronics Engineering (IEEE)
Institute of Data Processing Management
 
Institute of Marketing Management (IMM)
Information Technology Association (ITA)
Project Management Institute South Africa (PMISA)
Engineering Council of South Africa (ECSA)
SA Council of Automation and Computation
SA Institute for Computer Scientists
SA Institute of Electrical Engineering (SAIEE)
SA Institute of Computer Scientists and Information Technology (SAICSIT)
Other
 
Indicate your Indoor Leisure/Interests:
Reading
Computer Gaming
Arts and Culture
Debate
Photography
Electronics
Internet
Movies
 
Music
Software Development
Surfing the internet
Telecommunications
Web development
Robotics
Theatre
Other
 
Indicate your Outdoor Leisure/Interests:
Extreme Sports
Adventure Sports
Motor Sports
Water Sports
Racing
Action Sport
Athletics
Physical Sports / Team Sports
Club Sports
 
Angling
Recreational Sports
Outdoor - eg: Hiking / Camping
Aviation
Socialising
Travel
Wine and Dining
Golf
Other
 
Indicate which times of day/days of the week are convenient for you to attend SIG events:
Times of the Day  
Breakfast
Lunch
Morning
Afternoon
Evening
No preference
 
Days of the Week  
Monday
Tuesday
Wednesday
Thursday
Friday
No preference
 
Indicate how often you attend SIG events:
 
Indicate if seldom or never, what are the major factors:
Pressure of work
Too expensive
Topics not of interest
Other
 
Where you would prefer attending the SIG events:
City Centre
Suburbs North
South
East
West
 
Qualifications, Institution, Year and Country:
  Qualifications Institution Year Country
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
 
Please attach certified copies of all your Certification and Qualification Documentation (including SAQA Assessment for non-South African qualifications), proof of payment and a copy of your Curriculum Vitae (CV) here:
If you have more than 1 file, please zip it using a program like WinZip, Max 5MB, if you receive a blank page on submission, you file is too big. Please re-submit smaller file.
 
Declaration by Two Referees: (IITPSA members are preferred, but other persons of good standing are acceptable):
We recommend the applicant as being suitable for admission to the Institute. We agree to supply further information under confidential
cover in support of this application, if requested to do so.
Name E-mail Telephone Member No.

I agree to receive future marketing information from IITPSA: (Mandatory)
 
I hereby apply for admission to the Institute of Information Technology Professionals South Africa. (IITPSA) If admitted I hereby undertake to abide by the Constitution, Code of Professional Conduct, Rules and Regulations of the Institute. By clicking on the "Submit" button below I indicate my acceptance of these statements and certify that, to the best of my knowledge, all information submitted in this application and in support of this application is true and correct. I further acknowledge that the Institute has collected and will store and process my personal information submitted herewith for membership and related purposes, including, but not limited to processing of professional designations and providing other member services and benefits. I give my permission to IITPSA for my personal information to be stored, processed and shared in order to meet the requirements of providing such membership services and benefits.

Form version 13-August 2015