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Helderberg Harriers Membership Form
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* Required
Membership Application Type
*
New Membership
Renewal of Membership
Surname
*
Your answer
Full Birth Name (s)
*
Your answer
Casual Name
*
Your answer
Date of Birth
*
MM
/
DD
/
YYYY
Gender
*
Female
Male
ID Number
*
Your answer
Telephone Number (Home)
*
Your answer
Cellphone Number
*
Your answer
Telephone Number (Work)
*
Your answer
Email Address
*
Your answer
Postal Address
*
Your answer
Residential Address
*
Your answer
Please indicate your Facebook handle (should you not wish to be included, please ignore this question)
Your answer
Please indicate your Instagram account name (should you not wish to be included, please ignore this question)
Your answer
Please indicate preferred communication language
*
English
Afrikaans
What is your home language (or home languages)
*
Your answer
What is your present occupation / job / status?
*
Your answer
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
*
I can assist with the Spookhill 15km Race
I can assist with the Winelands 21km/42km
Required
Membership Category
*
Choose
Normal Member (HH Club Fee R180 + ASA License Cost R155 = R335)
Family Member (HH Club Fee R100 + ASA License Cost R155 = R255)
Junior Member (HH Club Fee R20 + ASA License Cost R45 = R65)
Social Member (HH Club Fee R100 + ASA License Cost R0 = R100)
Honorary Member
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:
*
Register with ASA via
http://asa.saclubs.co.za/
, if not yet registered
Complete compulsory ASA application form and email it to
info@helderbergharriers.co.za
Send copy of ID if Junior to
info@helderbergharriers.co.za
(under 19 years old) must provide a colour copy of ID document (Strict WP Rule)
Send proof of Payment to
info@helderbergharriers.co.za
: Licence numbers will only be provided when proof of payment is received
I paid using SnapScan
Required
Please read carefully and agree to the following terms and conditions
*
I undertake to abide by all the club rules and club decisions
I undertake to abide by all the rules of ASA and WPA
Required
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