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Aansoek om Lidmaatskap / Application for Membership

Volle name:
First Names: ___________________________		 Van:
Surname: ____________________________
Roep teken toegeken:
Call sign allocated: ______________________		 ID Nommer
ID Number: ___________________________
Straat adres:
Street address: ________________________		 Pos adres
Postal address: ________________________
______________________________________ ______________________________________
______________________________________ ______________________________________
______________________________________ ______________________________________
Poskode:
Postal code: __________		 Poskode:
Postal code: __________
Huis tel:
Home tel: __________________________________		 Werk tel:
Work tel: ___________________________________
e-pos:
e-mail: ____________________________________		 Selnommer:
Cell number: ________________________________
Ek is lid van klub (naam):
I am member of club (name): _________________________________________________________________
Lidnommer:
Member number: _____________________________		 Lid sedert:
Member since: ______________________________
Okkupasie:
Occupation: __________________________________________________________________________
Ek is bereid om te help met burgerlike noodgevalle:
I am prepared to assist in civil emergencies:		 Ja:
Yes:   _____		 Nee:
No:   _____
Radio tipe:
Radio type:		 Maak en model:
Make and model:		 Serienommer:
Serial number:
29m/VHF ________________________________________ ___________________________
29m/VHF ________________________________________ ___________________________
29m/VHF ________________________________________ ___________________________
indien meer as 3 radios, heg apparte vorm aan
if more than 3 radios, attach seperate form
Maak van voertuig:
Make of vehicle: ______________________________		 Registrasienommer:
Registration number:
Tipe lisensie/s:
Type of license/s:		   Vul jou behoefte in:
Enter your requirement:
Eerste keer aansoekfooi:
First time application fee:		 eenmalig:
once off:  R10.00		 R
29MHz lisensie per radio
29MHz license per radio:		 koste per jaar:
cost per annum:  R35.00		 R
VHF lisensie per radio:
VHF licence per radio:		 koste per jaar:
cost per annum:  R100.00		 R
ORRA jaarlikse inskrywing:
ORRA annual subscription:		 R20.00 R 20.00
 

U fooi betaalbaar:
Your fee payable:

 R

Bankbesonderhede:

Bank account detail:

OFF ROAD RADIO ASSOCIATION
First National Bank Edenvale Tak
Takkode: 25 13 42
Rekeningnommer: 5527 448 1908

Jou depositoverwysing is jou van, voorletters en roepsein indien beskikbaar.

OFF ROAD RADIO ASSOCIATION
First National Bank Edenvale Branch
Branch code: 25 13 42
Account number: 5527 448 1908

Your  deposit reference is your surname, initials and call sign if available.

Faks asb. bewys van betaling en hierdie aansoek na: 0866 955 617
Please fax proof of payment and this application to: 0866 955 617
Neem kennis: Aansoek vorms vir tweerigting radio lisensies uitgereik deur die "Off-Road Radio Association" is slegs vir lede van klubs geaffilieer aan die "Association of All Wheel Drive Clubs of South Africa". Indien jy nie 'n lid van een van hierdie klubs is nie, kontak asb. ICASA direk vir jou lisensie by 011-321-8200.

Ek verstaan dat hierdie lisensie slegs geldig is vir die huidige jaar, ongeag van wanneer in die jaar aansoek gedoen is.

Hiermee onderneem ek om gehoorsaam te wees aan die radio reëls van ICASA, ORRA en my AAWDC klub.

Ek onderneem om ORRA in kennis te stel sou ek besluit om nie my lisensie te hernu nie en ontslae te raak van genoemde radio toerusting in ooreenstemming met ICASA regulasies.

 Please note: Application forms for two-way radio licenses issued by the Off-Road Radio Association are only to members of clubs affiliated to the Association of All Wheel Drive Clubs of South Africa. If you are not a member of one of these clubs, please contact ICASA directly for your license on 011-321-8200.

I understand that this license is valid for the current year only, regardless of when in the year the application is made.

I hereby agree to abide by the radio rules of ICASA, ORRA and my AAWDC club.

I undertake to inform ORRA as and when I decide not to renew this license and to dispose of the relevant radio equipment in accordance with ICASA regulations.
Handtekening van aansoeker:
Signature of applicant:

.

_____________________________________

 Datum:
Date:

.

______________________________________
 

 

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Last modified: August 22, 2008

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