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CGMA MEMBERSHIP APPLICATION
To be completed by ALL members in each new season (re-registration) or by new members (first registration)
Surname *
Your answer
First name(s) *
Your answer
ID number *
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Current age group
e.g. M45 if male or W45 if female (in example it means 45-49 age group)
Your answer
Postal address *
Your answer
Email address *
Your answer
Phone number - mobile *
Your answer
Phone number - land line
Only required if you don't have a mobile phone
Your answer
CGA club
The athletics or running club you are a member of (where you train and/or where you obtain your ASA license number)
Your answer
ASA license number
If you already have one. Note it compulsory to have a license number to part take in the SA championship
Your answer
Medical aid
Your answer
Medical aid number
Your answer
Year joined CGMA
If you are already a member or have been in the past
Your answer
Year obtained CGMA colours
If you were awarded colours in the past
Your answer
Year obtained national colours
If you were awarded colours in the past
Your answer
Mandatory supplementary requirements
This membership form must be submitted in conjunction with payment of the annual fees (R350 for 2019). Your application is only considered upon receipt of these fees. To pay please EFT to the following: CENTRAL GAUTENG MASTERS ATHLETICS, Standard Bank account number 251853209 (account type Current, branch Clearwater, branch code 001 206). Use your name as a Reference on the deposit slip. Please forward proof of payment to Pam Immelman at centralgautengmasters@gmail.com, together with a copy of your ID or passport (if new member)
Your answer
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