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Ground Floor, Andries Bisschoff Building, Van der Hoff Road 427, Hercules.
Geregistreer by
MOTORSPORT S.A. |
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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. |
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AANSOEK OM
LIDMAATSKAP / APPLICATION FOR MEMBERSHIP
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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 _______________________ |
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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.
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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. |
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GETEKEN OP
HIERDIE
SIGNED ON THIS |
DAG VAN
DAY OF |
20 |
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HANDTEKENING
SIGNATURE |
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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. |
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Member
of: Off-Road Radio Association /
Association of All Wheel Drive Clubs
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4X4ATV
also incorporates: Rust de Winter 4X4
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