|
Posbus 28354
Sunnyside 0132
Tel: +27 12 379 1715
Faks: +27 12 377 3975
Sel: 082 558 6184
e-mail: 4x4atv@4x4atv.org
Geregistreer by
MOTORSPORT S.A.
|
MEMBER OF UNITED FOUR
WHEEL DRIVE ASSOCIATION OF U.S.A. AND CANADA
|
P.O.
Box 28354
Sunnyside 0132
Tel: +27 12 379 1715
Fax: +27 12 377 3975
Cell: 082 558 6184
e-mail: 4x4atv@4x4atv.org
Registered with
MOTORSPORT S.A. |
|
|
AANSOEK OM
LIDMAATSKAP / APPLICATION FOR MEMBERSHIP |
| VOORNAME /
CHRISTIAN NAMES |
| VAN /
SURNAME |
|
I.D. NO |
HUISADRES
RESIDENTIAL ADDRESS |
| HUIS / HOME
TEL NO |
WERK / WORK TEL NO |
| SEL / CELL NO |
FAKS FAX NO |
|
| e-pos /
e-mail |
ADRES waarheen
pos gestuur moet word
ADDRESS where post has to be sent to |
|
| WERKADRES
/
WORK ADDRESS |
| GETROUD
/
MARRIED |
YES /NO |
|
BEROEP /
OCCUPATION |
|
| 4X4 TIPE /
TYPE |
REGISTRASIENOMMER
/
REGISTRATION NUMBER |
|
TIPE van ENJIN en
MAAK en C.C.
TYPE of ENGINE and MAKE and C.C. (bv./eg.: V8 / V6 / V4) |
MODEL (J / Y) |
Adres en Tel. nr.
van 'n Naasbestaande (Nie woonagtig by bogenoemde adres nie)
Address and Tel. no. of next of kin (Not living at the above
Address) |
|
|
|
|
|
Ek onderneem om
myself te onderwerp aan al die Reëls 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 te rapporteer en om klubgelde stiptelik te
betaal voor of op 30 November van 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 Organisation
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 30 November of 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
|
|