Passport Photo, Max. 2MB (required)
Name (required)
Surname (required)
Email (required)
Mobile number (required)
Home number
Work number
Postal Address (required)
Home Address (required)
ID/Passport number (required)
Date of Birth (required)
Membership Type (required) ---Full Member R380.00Combined Full Member 570.00Country Member (>80km) R260.00Combined Country Member (>80km) R370.00Student Member R205.00Junior Member (14-18yo) R120.00Retired Full Member (>65yo) R250.00Retired Combined Full Member (>65yo) R360.00Honorary, Honorary Life or Life Member
I have attended the following official meets of the Eastern Province Section : (Meet descriptions, Date, Leader's name) 1. Meet Description: Leader:
2. Meet Description: Leader:
3. Meet Description: Leader:
I have attended the following Thursday evening social :
Have you ever been or are you a member of any other Section? ---YESNO Have you ever been refused membership of any other Section? ---YESNO Are you prepared to participate in rescue work? ---YESNO
I agree to abide by the Constitution and Rules of the Section
Date (required)
Signature (required, sign in the rectangle below) [signature* signature-applicant cols:300 rows:200 color:Black background:Yellow]
Proposer (full name) (required)
Seconder (full name) (required)