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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

Male

Female

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 *

YYYY

Direct Family Member1 First Name(s)

Direct Family Member1 Surname

Direct Family Member1 Date of Birth

YYYY

Direct Family Member2 First Name(s)

Direct Family Member2 Surname

Direct Family Member2 Date of Birth

YYYY

Direct Family Member3 First Name(s)

Direct Family Member3 Surname

Direct Family Member3 Date of Birth

YYYY

Direct Family Member4 First Name(s)

Direct Family Member4 Surname

Direct Family Member4 Date of Birth

YYYY

Undertaking *

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

Yes

Payment *

I still have to make payment

I have already made payment

Other:

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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