Newcastle Wheelers







AANSOEK OM LIDMAATSKAP/APPLICATION FOR MEMBERSHIP – 2020
Van/Surname: Naam/Name:
Mediesefonds:
Medical Aid:
Mediesefonds No:
Medical Aid No:
ID Nommer:
ID Number:
Geslag/Sex: MaleFemale
Posadres:
Postal Address:
Poskode:
Postal Code:
Telefoon No:
Telephone No: Cell
(H)
E-pos Adres
E-Mail Address:
Nood Tel No:
Emergency Tel No:
Kontakpersoon:
Contact Person:
XS S M L XL 1XL 2XL 3XL 4XL 5XL
Fietsryhemp Grootte /Cycling Shirt Size: XS S M L XL XL1 XL2 XL3 XL4 XL5
Fietsrybroek Grootte /Cycling Pants Size: XS S M L XL XL1 XL2 XL3 XL4 XL5
Armverwarmers/Arm warmers: XS S M L XL XL1 XL2 XL3 XL4
VERPLIGTE LEDEGELD PER JAAR/COMPULSORY ANNUAL MEMBERSHIP FEES
Ledegeld/Membership R 300.00 R 300.00
KlubKit/Club Kit (Hemp/Shirt) TBA
Totaal/Total R 300
I agree to all terms and conditions

Handtekening/Signature


Datum/Date

Betalings kan soos volg gemaak word/Payments can be made as follow:

  • Elektroniese Bankbetaling/ Electronic Fund Transaction (EFT) – Faks bewys/Fax confirmation: 086 513 0866
    FNB Tjekrekening/ FNB Cheque Account, Branch Code/Takkode 270 324, Rek/Acc no: 624 2571 3113
  • Kontantinbetaling slegs by Klubhuis op die eerste Donderdag van die maand / Cash payment at the Club House (only) on the
    first Thursday of each month 17h30 – 19h00
  • NO CASH/CHEQUE PAYMENTS AT BANK/GEEN KONTANT/TJEK INBETALINGS BY BANK!!!! (Additional R20 shall be
    charged/ Addisionele R20 bybetaling sal gehef word)
  • Nota: CSA lidmaatskap en Lisensie aansoeke moet self op webtuiste gedoen word / CSA Membership and License
    applications must be done by yourself on website: www.cyclingsa.com

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