Cola Myoli Conservancy Membership Form

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

If you would like to join our conservancy, please complete the form below.

First Name and Surname *

Street Address *

Email address *

Cell phone number

Home phone number

Membership fee/donation per annum (please note your preference)

R100 (R8.30 per month)

R200 (R16.60 per month)

R300 (R25.00 per month)

R600 (R50.00 per month)

Other (please specify the amount below)

Clear selection

If you selected other above, please indicate the amount you will pay per annum below.

As per Cape Nature, the membership fee is a minimum of R100 per year, but you can choose a higher amount if that is appropriate for you. We use these funds towards our approved projects which are in line with our vision.

Please email your proof of payment to us: colaconservancy@gmail.com

On behalf of the Cola Myoli Conservancy

Mrs Adrienne Bartlett (Treasurer)

By completing this document you confirm that you, as the person/entity/body/individual/company who is providing information and hereinafter collectively referred to as the member, do hereby irrevocably agree and understand that any and all information supplied or given to the Cola Myoli Conservancy and its representatives is done so in terms of the POPI Act of South Africa (Protection of Personal Information Act). We will not sell or forward any information handed to us in the this form and we will only use it for the purposes for which it is intended. You also herewith agree to receive information from the Cola Myoli Conservancy pertaining to the membership or any information which we deem necessary to share regarding the Cola Myoli Conservancy.

Submit

Clear form

Never submit passwords through Google Forms.

This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report

Forms