Helderberg Harriers Membership Form
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Membership Application Type *
Surname *
Full Birth Name (s) *
Casual Name *
Date of Birth *
MM
/
DD
/
YYYY
Gender *
ID Number *
Telephone Number (Home) *
Cellphone Number *
Telephone Number (Work) *
Email Address *
Postal Address *
Residential Address *
Please indicate your Facebook handle (should you not wish to be included, please ignore this question)
Please indicate your Instagram account name (should you not wish to be included, please ignore this question)
Please indicate preferred communication language *
What is your home language (or home languages) *
What is your present occupation / job / status? *
We need each Helderberg Harriers member to help or support the club with SOMETHING during the course of this year, please indicate and or complete *
Required
Membership Category *
Banking Details for direct deposit / EFT payment:
Account Name:   Helderberg Harriers            
Account No:        62804453851
Bank:                    First National Bank      
Use your NAME & SURNAME as reference



Application Checklist: Please check that you have completed the necessary steps: *
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Please read carefully and agree to the following terms and conditions *
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