Senior Registration Form - 2024
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Section A: Basic Information

First Name *
Surname *
Initials
Title ( Mr, Ms, Mrs, Dr, etc)
*
Date of Birth
*
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M/F *
ID Number
*
Home Language
*
Address *
Home Telephone Number
*
Work Telephone Number
*
Mobile Number
*
Occupation
*
Company / Institution 
*
Name of Medical Aid
*
Main Member: Name *
Membership Number
*
Section B: Member Profile Hockey Related Achievements (Provincial, zonal or school caps, coaching courses attended etc.) Use additional sheet if required. *
Hockey Related Achievements (Provincial, zonal or school caps, coaching courses attended etc.) Use additional sheet if required.
Select the option(s) which apply to you
*
Required
Disclaimer - CHC Privacy policy

I hereby provide consent to CHC that my information is utilised for Central Hockey Activities which includes my personal information and media in accordance with the CHC privacy policy.

http://www.centralhockey.co.za/wp-content/uploads/2021/07/CHC-Privacy-Policy-30-june-2021-1.pdf
*
Required
I herewith apply for membership of Central Hockey Club (CHC) and undertake to: adhere, promote and support the aims and objectives as outlined in its Constitution, Code of Conduct, Privacy Policy and other official document; perform all hockey activities under the auspices of CHC and understand that I can only be released from this obligation under exceptional circumstances; absolve CENTRAL HOCKEY CLUB and OFFICIALS from liability for any loss, damage, or injury to my person or effects arising from any reason whatsoever during the period of my membership. I understand that this application is only valid on payment of the Season Fee in full or the registration fee of R345.00 or R550.00 (whichever is applicable) on the Season Fee with the balance paid IN FULL over 3 months: at the end of March, April, May 2024. 

Please sign below *


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