NB: All new membership applications will incur a non-refundable application fee, which is payable before the application is processed. See Annual Fees for details.

NB: Membership applications incur a non-refundable application fee, which is payable when submitting this form and before the application is considered. See Annual Fees (https://www.samra.co.za/category/membership/membership-fees/) for details.

Confidentiality

All reporting regarding membership is at aggregate level. All details and information submitted is strictly confidential.

ABOUT YOU

Curriculum Vitae

Please submit your current CV to membership@samra.co.za, including the details and email addresses of at least two contactable references, and copies of your qualification certificate(s).

Please tell us why you would like to be a SAMRA Independent member? (Up to 500 words) *

Title *

All Given Name(s) *

Surname *

Name Known As *

Gender *

Race *

Please note that this question is included because we have to report on this, at aggregate level, to government agencies in South Africa

Country of Residence *

Country of Birth / Citizenship *

Identity Number *

Birthday (Format: mm/dd/yyyy) *

WHAT YOU DO

Employer Organisation *

What is the primary focus of the above organisation? *

Current Position *

Date appointed in current position (Format: mm/dd/yyyy) *

Role *

The role that you fulfil most of the time at work.

SECTOR(S) in which you have worked in the last 12 months *

If you are on user/client/buyer side, this question applies to the work you have done internally, as well as commissioned externally. Categories are based on the ESOMAR global classification system.

	Yes	No
Manufacturing: Consumer Non-Durables (FMCG)
Manufacturing: Consumer Durables
Manufacturing: Pharmaceutical products and services (Rx – prescription)
Manufacturing: Automotive
Manufacturing: Other
Business-to-business and industrial
Wholesale and retail (incl. oil, commercial farming, agriculture)
Financial services
Utilities (incl. gas, electricity, water, private and public postal services, etc.)
Telecommunications and Information and Communications Technology
Public sector, academic and public institutions, NGOs
Media, entertainment, tourism and hospitality
Advertising agencies, Strategy and communications companies, Brand consultants
Research institutes

QUANTITATIVE methods you have worked with in the last 12 months *

	Yes	No
Postal mail self-completion questionnaire
Telephone interviewing (CATI) (including CATI to mobile)
Face-to-face interviewing (PAPI/CAPI)
Self-completion questionaire using an online device
Online traffic / audience measurement, including website measurement
Automated digital/electronic including retail audits and media measurements and interactive voice recording interviews

Categories are based on the ESOMAR global classification system.

QUALITATIVE methods you have worked with in the last 12 months *

	Yes	No
Group discussions / focus group interviews
In-depth (individual) interviews
Communities and panels
Self-reporting (e.g. vox pops, blogging, written diaries, photo diaries)
Observation (e.g. ethnography, immersions, shopper research)

Categories are based on the ESOMAR global classification system.

BIOMETRIC MEASURES you have worked with in the last 12 months *

	Yes	No
Facial coding
Eye-tracking
Functional magnetic resonance imaging (fMRI)
Positron emission tomography (PET)
Electroencephalography (EEG)
Steady state topography (SST)
Transcranial magnetic stimulation (TMS)
Electro Dermal Activity (EDA)/galvanic skin response
Electromyography
Electrocardiography (ECG)
Implicit Association Test (IAT)

Categories are based on the ESOMAR global classification system.

DESIGNS you have worked with in the last 12 months *

Categories are based on the ESOMAR global classification system.

YOUR CONTACT DETAILS

Email Address *

Mobile Nr *

Phone Nr (Work) *

Postal Address (Personal) *

For example: PO Box 1713, Randburg, 2125, South Africa

Physical (Delivery) Address (Personal) *

For example: 264 Oak Avenue, Randburg, 2125, South Africa

TERMS AND CONDITIONS

I hereby certify that: *

(Please indicate agreement by ticking the relevant boxes)

The information set out in this submission is complete (all fields are compulsory), true and correct to the best of my knowledge.

I will abide by the Southern African Marketing Research Association (SAMRA) Memorandum of Incorporation and Company Rules, and the SAMRA Code of Conduct.

I will ensure payment of any fees due to SAMRA.

I understand and agree that by submitting this application form I am liable for the non-refundable application fee, which is payable before the application is considered.

I accept liability for the once-off, non-refundable application fee which becomes due when I submit this form.

I understand that, if approved, I will remain a member of SAMRA until such time as a valid resignation is submitted to and received by SAMRA, or membership is withdrawn by SAMRA.

I meet the requirements for SAMRA Independent Membership. (see http://www.samra.co.za/membership/membership-criteria/)

This application will expire within 120 days of submission if incomplete and/or application fees are not paid and/or membership fees are not paid. All invoiced amounts remain due. Once an application has expired, a new application will have to be submitted for approval, and a new application fee will become due.

I understand that once invoiced, the application fee remains due, irrespective of whether the application expires after 120 days, or is approved or not.

	Yes	No
Ad hoc research
Omnibus (syndicated) surveys
Panel research
Other continuous tracking research

Independent Membership Application Form

ABOUT YOU

WHAT YOU DO

YOUR CONTACT DETAILS

ESOMAR News

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