Surname :
Van : ...................................................................................
Call / Roepsein..........................
First Names :
Date of birth:
Voorname : .........................................................................
Geboortedatum : ........................
Postal address:
Post Code :
Posadres :..............................................................................Poskode:...................................
Packet Ad : ................................................ email:
...............................................................
Residential address :
Woonadres:..........................................................................................................................
.............................................................................................................................................
Home Tel.
Sellulere Tel :
Work Tel :
Huis Tel : .............................. Cellular Tel : ........................................
Werk Tel :................
Occupations/Profession (past or present) :
Beroep/Professie (huidig of verlede) : ..........................................................................................
Hobbies other than amateur radio :
Stokperdjies anders as amateur radio : .........................................................................................
Preferred Language (English/Afrikaans) :
Voorkeurtaal (Engels/Afrikaans) :......................................
I wish to apply for the following membership ORDINARY / SPOUSE / CHILD.
Ek doen graag aansoek vir GEWONE / GADE / KIND lidmaatskap.
If accepted as a member I undertake to be bound by and uphold the Club
Constitution and Rules.
Ek onderneem dat indien ek as lid aanvaar word dat ek die Grondwet
en reels van de klub sal nastreef en daardeur gebind sal word.
Signed :..............................................Date :........................
Member of SARL.......Yes/No.
Proposed by :
Callsign :
Voorgestel deur :.............................................................
Roepsein :................................
Seconded by :
Callsign :
Gesekondeer deur :...........................................................
Roepsein : ..............................
LW / NB :
Sluit asseblief lidmaatskapgeld by die aansoek in, Gewone lid R30.00
Gade/Kind R15.00
Please enclose fees with application. Member R30.00 Spouse/Child
R5.00
Please list overleaf Birthdays and Anniversaries of your family you
wish to be announced on bulletins.
Dui asb. verjaarsdae en herdenkings van u en u familielede op die keersy
van die bladsy aan.