Application Form

1Details

Title

First Name

Last Name

Gender

Marital Status

Telephone

Cell

Date Of Birth

2Physical Address

Address

Address 2

Suburb

City

Postal Code

Province

Country

Same as Physical Address

3Postal Address

Address

Address 2

Suburb

City

Postal Code

Province

Country

4Other

Occupation

Employer

Details of Membership of Any Fishing Clubs

5Membership Type

Membership Type

Member Type	Entrance Fees	Annual Fees
The Committee may change entrance fees, annual subscription/membership fees and other fees for any classes of membership at any time.
Ordinary	R575.00	R1,050.00
Junior (Under 18)	R220.00	R350.00
Student	R220.00	R350.00
Ordinary Penalty Fee	R100.00	R0.00

6Add a Family Member

Membership Type

First Name

Last Name

7Feedback

How did you hear about us?

8Are you Human?

Characters to Match:

Enter Characters:

9Declaration

By checking this box I hereby solemnly declare that the above information is true. I have never been convicted of any offence under the game laws, ordinance or regulations. I have not been disciplined by any club. In the event of this application being accepted, I undertake to abide by the constitution and regulations of the club.

Application Form

1Details

2Physical Address

3Postal Address

4Other

5Membership Type

6Add a Family Member

7Feedback

8Are you Human?

9Declaration

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