OPEN FOR REGISTRATION

Annual Fees:
R 400 for main member
or
R 600 for family

BANK DETAIL
Bank: FNB
Account Name: STEINITZ
Account no: 62804544064
Branch: CAPE GATE
Branch Code : 250655
Account Type: Current Account

Please email proof of payment and direct any payment queries to Ilze de Kock - Ilze@accprof.co.za

Please answer all the questions
First Name(s) *
Main Member First Name
Surname *
Main Member Surname
Gender *
Main Member Gender
Residential Address *
E-Mail Address *
Cell Phone Number *
Do not type hyphens or spaces.
Landline
Do not type hyphens or spaces.
Main Member Date of Birth *
MM
/
DD
/
YYYY
Direct Family Member1 First Name(s)
Direct Family Member1 Surname
Direct Family Member1 Date of Birth
MM
/
DD
/
YYYY
Direct Family Member2 First Name(s)
Direct Family Member2 Surname
Direct Family Member2 Date of Birth
MM
/
DD
/
YYYY
Direct Family Member3 First Name(s)
Direct Family Member3 Surname
Direct Family Member3 Date of Birth
MM
/
DD
/
YYYY
Direct Family Member4 First Name(s)
Direct Family Member4 Surname
Direct Family Member4 Date of Birth
MM
/
DD
/
YYYY
Undertaking *
I undertake to adhere to the principles, rules and regulations of Steinitz CHESS CLUB
Payment *
Payment Amount Paid or To Be Paid *
Please do NOT type R for Rands • Simply type the number
Payment Description
Please take a moment to describe what payment was made for (in words), which will help us identify deposits.
Comments
Please indicate anything further which you feel we should know about, including disabilities.
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