2021 MEMBERSHIP REGISTRATION & RENEWAL FORM

FOM is a registered Public Benefit Organisation 930055453

MEMBERS’ CONFIDENTIAL INFORMATION

The (*) indicates required information

First Name *

Last Name *

Email address *

Address *

Telephone

Mobile

Would you like to be an active member and help with our events?

Yes

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How did you hear about FOM? *

Type of Membership *

Student R100

Regular R200

How Many Memberships are you buying? *

DONATIONS

Please select one:

General Donation: for all FOM activities

Donation to qualify for an 18a Certificate (for education only) - minimum R500

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PLEASE CONFIRM TOTAL AMOUNT

(Your membership amount plus your donation)

TOTAL AMOUNT *

BANKING DETAILS: Please use Your Name as the beneficiary reference for your payment, so that we can allocate your payment to your membership.

Proof of payment via email: mrusso@mweb.co.za
(FOM Treasurer Stephen Russo)

Thank you!

EFT Details
Standard Bank, Rondebosch
Branch: 025009
Account Name: Friends of Orchestral Music
Account No: 071 03 1146
Beneficiary Reference: Your Name
SWIFT Code: SBZAZAJJ

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