Club Registration Application Form

CLUB AFFILIATION APPLICATION FORM – 2013

 

Name of Club

 

Province

 

Club Postal Address

 

 

                                                                                    Code:

Club Physical Address

 

 

 

Telephone No. of Club

 

No. of Initial Club Members

(min 10):

 

Disciplines Available

(lead &/or bouldering and/or speed)

 

Club Facilities Available:

(e.g. Clubhouse etc).

 

 

Club colours

(Describe Club colours).

 

 

1. PRESIDENT’S DETAILS

 

Name:

Tel No: (W)

Fax No:

Cell:

Email:

Postal Address:

 

                                                                                                                                                Code:

 

2. VICE PRESIDENT’S DETAILS

 

Name:

Tel No: (W)

Fax No:

Cell:

Email:

Postal Address:

 

                                                                                                                                                Code:

 

 

 

3. SECRETARY’S DETAILS

 

Name:

Tel No: (W)

Fax No:

Cell:

Email:

Postal Address:

 

                                                                                                                                                Code:

 

4. TREASURER’S DETAILS

 

Name:

Tel No: (W)

Fax No:

Cell:

Email:

Postal Address:

 

                                                                                                                                                Code:

 

Climber Fees for 2013 (per member):

Western Cape Climbing:           R  40-00

SANCF:                                     R120-00

Total Due:                                R160-00

 

Climber fees can be paid directly into our bank account

Western Cape  Climbing          

Bank: FNB

Branch: 204209

Account No: 62380592652                 

Cheque Account

 

Signed: ________________________________________________   Date: __________________________________

 

PLEASE ALSO SUBMIT A COPY OF YOUR CLUB CONSTITUTION AND FOUNDING RESOLUTION