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Ground Floor, Andries Bisschoff Building, Van der Hoff Road 427, Hercules.

Geregistreer by
MOTORSPORT S.A.

P.O. Box 28354
Sunnyside 0132
Tel: +27 12 379 1715
Fax: +27 12 377 3975
Cell: 082 558 6184
e-mail:
admin@4x4atv.org

Registered with
MOTORSPORT S.A.

AANSOEK OM LIDMAATSKAP / APPLICATION FOR MEMBERSHIP

VOORNAME
CHRISTIAN NAMES

___________________________________
VAN
SURNAME

___________________________________
ID No

___________________________________
HUISADRES
RESIDENTIAL ADDRESS

___________________________________

___________________________________
Poskode
Postal code _______
HUIS TEL
HOME TEL __________________________
SEL
CELL ______________________________
e-pos
e-mail _____________________________
POSADRES 
(waarheen jou pos gestuur moet word)
POSTAL ADDRESS 
(where your post must be sent to)

___________________________________

___________________________________
Poskode
Postal code _______
GETROUD J / N
MARRIED Y / N

BEROEP
OCCUPATION _________________________
WERKADRES
WORK ADDRESS

____________________________________

____________________________________
WERK TEL 
WORK TEL __________________________________
4X4 VOERTUIG
4X4 VEHICLE ________________________________
MODEL (Jaar)
MODEL (Year) _______________________________
Tipe enjin en maak en cc
Type of engine and make and cc (bv. / eg. V4 / V6 / V8) ______
REGISTRASIENO
REGISTRATION NO ____________________

Adres van naasbestaande (nie woonagtig by dieselfde adres)
Address of next of kin (not living at the same address)

____________________________________

____________________________________

____________________________________
Naasbestaande tel 
Next of kin tel _______________________

Ek onderneem om myself te onderwerp aan al die Reëls en Regulasies van die Organisasie soos uiteengesit in die Konstitusie en Bylae daartoe en ook sodanige reëls as wat die Komitee mag uitvaardig van tyd tot tyd, om alle adresveranderings so spoedig moontlik skriftelik aan die Organisasie deur te gee en om klubgelde stiptelik te betaal voor of op die laaste dag van Februarie elke jaar of die Organisasie 60 dae voor die bogenoemde datum skriftelik in kennis te stel van my voorneme om te bedank uit die Organisasie. 

I undertake to adhere and subject myself to all the rules of the Organisastion and more specifically those set out in the Constitution and Bylaws and such rules made by the Committee from time to time, to report all changes of address promptly to the Organisation and to pay all dues on or before the last day of February each year or alternatively to notify the Organisation in writing 60 days before the above mentioned date of my intention to resign from the Organisation. 
GETEKEN OP HIERDIE
SIGNED ON THIS
DAG VAN
DAY OF
20
HANDTEKENING
SIGNATURE
* HIERDIE VORM MOET TERUGGESTUUR WORD AAN BOGENOEMDE ADRES SAAM MET TWEE PASPOORT FOTOS EN R_________ LEDEGELD. * THIS FORM MUST BE RETURNED TO THE ABOVE MENTIONED ADDRESS INCLUDING TWO PASSPORT PHOTOS AND R_________ MEMBERSHIP FEE.

Member of:   Off-Road Radio Association /
Association of All Wheel Drive Clubs

4X4ATV also incorporates:   Rust de Winter 4X4

Indien u voorgestel word deur 'n bestaande lid, verskaf asb. sy lidnommer:  
If you were introduced by an existing member, please submit his membership number:

*   Druk asseblief 'n afskrif van hierdie vorm uit om in te vul en volg insturksie.
*   Please print a copy of this form to fill out and follow instruction.

;-)

Administration fee, new members: R150.00
Annual membership fee: R400.00 

* You may deposit the required fees into the 4X4ATV Organisation bank account but will still need to send your original form and photos to the club office's street address.

Please enter your name in the reference field and insist the cashier enters this detail. Write "new member" on the deposit slip and fax to 012 377 3975

4X4ATV Bank Account Detail: 
ABSA
Branch code: 334 245
Account number: 0600 720 708

 

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Copyright © 2008 4X4ATV Organisation
Last modified: November 18, 2008

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