Member Registration Form InstagramThis field is for validation purposes and should be left unchanged.COALTECH RESEARCH ASSOCIATIONSelect Type of Membership(Required)AssociatesIndividualsCoal ProducerIndividual InformationName and Surname(Required)Company Street Address(Required)Postal Address (If Different)Email(Required) Telephone Number(Required)Company InformationCompany Name(Required)Company Registration NumberCompany Street Address(Required)Postal Address (If Different)Website URL Company’s Main Business(Required)Contact Person DetailsContact Person Name(Required)Contact Email(Required) Contact Telephone Number(Required)Membership Details Membership Options - Select the option(s) for your Company:Individual Member Individual Membership Fee R1,500 ex VAT PA Research Focus Areas Mining/Engineering Coal Processing Surface Environment Future Technologies * Fee R100,000 ex VAT PAResearch Focus Areas Mining/Engineering Coal Processing Surface Environment Future Technologies * Fee R1,500 ex VAT PAResearch Focus Areas Mining/Engineering Coal Processing Surface Environment Future Technologies * Fee R30,000 ex VAT PATotalTotalTotalRepresentative Coaltech representative & Alternative representativeName(Required)Coaltech representative (Person that will represent the Company) Email(Required) Contact Number(Required)Alternative RepresentativeNameAlternate representative (Alternate that will stand-in for representative): Email Contact Number
