MIDRAND CHESS CLUB

The House of Chess in Midrand

Kris Eale Midrand Chess Club Mobile: +27 846 50 79 89 Email:kris.eale@midrandchessclub.com www.midrandchessclub.com

Old Pretoria Main Road Midrand business park, Halfway, Midrand 1686 Johannesburg, South Africa

________________________________________________________________________________ MIDRAND CHESS CLUB MEMBERSHIP APPLICATION FORM

APPLICANT INFORMATION

Surname and First names: Physical Current address: Suburb: Postal address: Suburb: Date of Birth: Province: Age:
IF UNDER 18 PARENT INFORMATION

Province:

Postal Code:

Postal Code: Sex:

Surname and First names: Physical address: Suburb: E-mail: Relationship with the child: Province: Cell ID No: Postal Code: Phone:

MEMBERSHIP INFORMATION

PLEASE SELECT THE TYPE OF MEMBERSHIP SUITABLE FOR YOU Chess Player Promotion: End 30th October 2013: R150 Family Membership Promotion: Chess Player Adult: R400 Chess Player Child : R200 R250 Chess Coach Promotion R150

Family Membership (for 2 parents +2 Children): R600

Free Membership: Chess Coach R300: Senior Members only

Child under 7 Private Lessons School Lessons

AGREEMENT (BY ADULTS AND GUARDIANS)

I . , I would like to confirm that I am applying for a membership as mentioned above to the Midrand Chess Club (MCC) and I agree to comply with the MCC rules of fraternity, respect and Fair Game . 1

1.

Please check one below:

_____ New Members : If you are applying for membership, you may send your completed registration via email, make deposit to the bank account and send the proof of payment : Info@midrandchessclub.com . Once your registration is received, you will be contacted by the MCC within 7-10 days. How did you find out about us? ____________________________________________________ _____ Current Members : If you are renewing your membership, please send your c ompleted registration form and membership fee payment to the same address. Membership fees are payable by cash at the weekend playground or deposit on our provisionary account: ______if you want to receive our newsletter via email (Yes/No) 2. 3. 4. Member card can be collected by request on the weekend playground The Membership fees include free Coaching for Kids 2 Details: Bank details: Fist National bank, Account: 62210423571: type Cheque : Account Holder: Mr KE.EALE branch code: 254805 Physical Address: Halfway House library Midrand Business Park Mobile: +27 84 650 79 89

Email: info@midrandchessclub.com
Date

Signature of applicant (If older than 17)

Signature of co-applicant, if for family membership

Date

We look forward to welcoming you and your family to the Midrand Chess Club.

Midrand Chess Club,www.midrandchessclub.com /Midrand Business Park: Midrand Library: +27 84 650 79 89 Midrand Chess Club, www.midrandchessclub.com/Midrand Business Park: Midrand Library: +27 84 650 79 89