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

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• INITIALS FIRST NAME
• IDENTITY NO *Compulsory field
• (W) (CELL)
• NAMES (S) IF MEMBER OF ANY OTHER CLUBS
• APPLICANT’S SIGNATURE

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 Directory: wp-content -> uploads -> 2017 2017 -> Leadership ohio 2017 -> Ascension Lutheran Church Counter’s Schedule January to December 2017 2017 -> Board of directors juanita Gibbons-Delaney, mha, rn president 390 Stone Castle Pass Atlanta, ga 30331 2017 -> Military History Anniversaries 16 thru 31 January Events in History over the next 15 day period that had U. S. military involvement or impacted in some way on U. S military operations or American interests 2017 -> The Or Shalom Cemetery Community Teaching on related issues of Integral 2017 -> Ford onthult samenwerking met Amazon Alexa en introduceert nieuwe navigatiemogelijkheden van Ford sync® 3 met Applink 2017 -> Start Learn and Increase gk. Question (1) Name the term used for talking on internet with the help of text messege? 2017 -> Press release from 24. 03. 2017 From a Charleston Car to a Mafia Sedan 2017 -> Tage Participants 2017 -> Citi Chicago Debate Championship Varsity and jv previews Download 129.31 Kb. Share with your friends: