Application Details

Contact Details

Request Received
Alliance
This is a Lifetime membership
This membership includes Unlimited member slot(s)

An Alliance Member is represented by all Trade organisations such as pharmaceutical and equipment manufacturers and suppliers. 

Glue Up account creation information.

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Uploading an image is mandatory

Please enter a first name
If you input more than 0 characters your First Name may not display properly

Please enter a last name
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・8 characters minimum
・one upper case letter
・one lower case letter
・one number
・one special character (@$!%*?&)
If you input more than 0 characters your Password may not display properly


・8 characters minimum
・one upper case letter
・one lower case letter
・one number
・one special character (@$!%*?&)
If you input more than 0 characters your Confirm password (at least 8 characters) may not display properly

Please fill in your individual information.

Please fill in the below form with your company details.

Click here to upload a new image
Uploading an image is mandatory

Please enter a company name
If you input more than 0 characters your Company Name may not display properly

Please enter a valid url
e.g. https://app.glueup.com
If you input more than 0 characters your Website may not display properly

Please enter a valid phone number including country code
If you input more than 0 characters your Phone may not display properly
Primary Contact Person

If you input more than 0 characters your First Name may not display properly

If you input more than 0 characters your Surname may not display properly

Please enter a valid phone number including country code
If you input more than 0 characters your Mobile Number may not display properly

If you input more than 0 characters your Designation / Job Title may not display properly
Billing / Financial Details

If you input more than 0 characters your Company Registration Number (If Applicable) may not display properly

If you input more than 0 characters your Organisation VAT Number may not display properly

If you input more than 0 characters your Postal Address Line 1 may not display properly

If you input more than 0 characters your Address may not display properly

If you input more than 0 characters your City may not display properly

If you input more than 0 characters your Postal Code/Zip Code may not display properly

If you input more than 0 characters your Vendor Number may not display properly

If you input more than 0 characters your Name of Accounts / Invoicing Contact may not display properly

Please enter a valid phone number including country code
If you input more than 0 characters your Accounts Phone Number may not display properly

Terms & Conditions


As a SASA Alliance member, all representatives agree to the following:

  • To abide by the Constitution and Privacy Policy of the Society. For a copy of these documents, please email ops@sasaweb.com. 
Please select an option

Consent

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