VOORSITTER/CHAIRMAN ONDERVOORSITTER/VICE CHAIRMAN SEKRETARESSE/SECRETARY

Colin Davidowitz Brian Mc Farlane Adri le Roux

082 579 5543 082 320 1288 072 384 1184
cdavidowitz@oldmutual.com briansharkdiving@gmail.com jeanadrileroux@gmail.com

APPLICATION FOR MEMBERSHIP 2023/2024

NEW MEMBER'S DETAILS:

NAME: Luke van Schoor

.................................................

ADDRESS: ..................................................... POSTAL ADDRESS: ..................................

71 Da gama
.....................................................
7140
..................................
street Strand
..................................................... ..................................

TEL NR OFFICE: ........................................ HOME: ..............................................

0703055202088
CELL: ........................................ I.D. NR: .............................................

DATE: ........................................ PERMIT NR: .............................................

E-MAIL: ........................................ FAX NR: .............................................

I undertake to abide to the rules of the club, which from time to time are subject to change by the club
Committee. All club membership fee's to be paid timeously.

Do you know any current Committee Member? YES ............... No ...............

Any misconduct on my part will result in immediate termination of membership.

SUBSCRIPTION RATES FOR 2023/2024

Annual Full Membership: R750.00
Annual Spouse Membership: R600.00
Annual Junior Membership: u/21 R550.00
Annual Junior Membership: u/16 R450.00
Social membership: R200.00

Account Details:
ABSA BANK HERMANUS
CHEQUE ACCOUNT
ACC NR: 4072244369
BRANCH: 334 812
Applicant Signature: .................................................................

FOR OFFICE USE ONLY:

Only committee members may nominate and second prospective members.

Nominated: ......................................... Membership No: ..............................

Chairman:
Seconded: Colin Dawidowitz
......................................... Secretary: Adri Le RouxNo:
Membership Treasurer: Elzaan Karg
...............................
082 579 5543 072 384 1184 071 676 9588