Membership Application Form for INERELA+ and Friends of INERELA+. All information on this form will be treated as highly confidential. You can download this form here.

INERELA+ 3rd Floor, 21 Girton Road, Parktown, Johannesburg, 2006, South Africa. Tel: +27-11-484-0088 Fax: +27-11-482-9107. Email: info [at] inerela.org

Section A – To be filled in by every applicant (PLEASE USE ONLY BLOCK CAPITAL LETTERS)

Section B - To be filled out by all religious leaders. (PLEASE USE ONLY BLOCK CAPITAL LETTERS)

Section C – To be filled in by all HIV Positive applicants. (PLEASE USE ONLY BLOCK CAPITAL LETTERS)

Section D – To be filled in by all who are personally affected. (PLEASE USE ONLY BLOCK CAPITAL LETTERS)

I have filled in all information to the best of my knowledge. And understand it to be true and correct. I understand that misrepresentation of information in this application leads to automatic exclusion of membership.