Please print and complete this form nb: supply recent passport size photograph and relevant payment amount



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Date15.01.2018
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APPLICATION FOR MEMBERSHIP
2013

PLEASE PRINT AND COMPLETE THIS FORM

NB: SUPPLY RECENT PASSPORT SIZE PHOTOGRAPH

AND RELEVANT PAYMENT AMOUNT

MEMBERSHIP

ORDINARY

COUNTRY

STUDENT

SENIOR[65YRS]

CREW

RECENT PHOTO




ENTRANCE FEE

N/A

N/A

N/A

N/A

N/A







SUBSCRIPTION

2000.00

1300.00

1200.00

1200.00

1200.00




VAT

280.00

182.00

168.00

168.00

168.00




SUB-TOTAL

2280.00

1482.00

1368.00

1368.00

1368.00




WPDSAA AFF FEE *Compulsory fee

*120.00

*120.00

*120.00

*120.00

*120.00




TOTAL

2400.00

1602.00

1488.00

1488.00

1488.00







SURNAME

INITIALS

FIRST NAME




NAME OF SPOUSE




OCCUPATION







IDENTITY NO *Compulsory field







ADDRESS










POSTAL CODE








TEL NO: (H)

(W)

(CELL)







E-MAIL








BOAT NAME












NAMES (S) IF MEMBER OF ANY OTHER CLUBS








I HEREBY AGREE TO ABIDE BY THE RULES AND BYLAWS OF THE ATLANTIC BOAT CLUB’S CONSTITUTION

DATE


APPLICANT’S

SIGNATURE





PROPOSED BY CLUB MEMBER (Print name)

PROPOSER’S

SIGNATURE
DATE

SECONDED BY CLUB MEMBER (Print name)

SECONDER’S

SIGNATURE
DATE

SIGNED BY COMMITTEE MEMBERS:

NAME/SIGNATURE (1)



NAME/SIGNATURE (2)

APPROVAL BY COMMITTEE: YES / NO


DATE







For office use: Method of payment: Cheque/Cash Part Payment/ Instalments: Receipt details: No/Date

Direct payments – Atlantic Boat Club FNB 204009 a/c 62004235885
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