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

This is a required question

Surname

Main Member Surname

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Gender

Main Member Gender

Male
Female

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Residential Address

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E-Mail Address

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Cell Phone Number

Do not type hyphens or spaces.

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Landline

Do not type hyphens or spaces.

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Main Member Date of Birth

Direct Family Member1 First Name(s)

This is a required question

Direct Family Member1 Surname

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Direct Family Member1 Date of Birth

Direct Family Member2 First Name(s)

This is a required question

Direct Family Member2 Surname

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Direct Family Member2 Date of Birth

Direct Family Member3 First Name(s)

This is a required question

Direct Family Member3 Surname

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Direct Family Member3 Date of Birth

Direct Family Member4 First Name(s)

This is a required question

Direct Family Member4 Surname

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Direct Family Member4 Date of Birth

Undertaking

I undertake to adhere to the principles, rules and regulations of Steinitz CHESS CLUB

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Payment

I still have to make payment
I have already made payment
Other:

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Payment Amount Paid or To Be Paid

Please do NOT type R for Rands • Simply type the number

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Payment Description

Please take a moment to describe what payment was made for (in words), which will help us identify deposits.

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Comments

Please indicate anything further which you feel we should know about, including disabilities.

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