Fynbos Membership Application Form

Complete the application form below and note that all fields with a * are compulsory.

Membership Application form

Surname / Van *

Name / Naam *

Identity number / Identiteitsnommer *

Date of birth / Geboortedatum *

Contact details

Physical address / Straatadres * (include postal code)

Postal address / Posadres * (include postal code)

Landline phone / Landlyn nommer

Mobile phone / Selfoonnommer *

Email address / Epos-adres *

Language / Taal *

Marital status / Huwelikstatus *

Gender / Geslag *

Church affiliation / Kerkverband *

Profession with retirement / Beroep met aftrede *

Household / Huishouding *

Has your financial position changed in the last 5 years? / Het u finansiële posisie in die laaste 5 jaar verander? *

Monthly income / Maandelikse inkomste *

Relatives / Naasbestaandes

Name and surname / Naam en van *

Relationship / Verwantskap *

Landline number / Landlyn nommer

Mobile phone / Selfoonnommer *

Name and surname / Naam en van *

Relationship / Verwantskap *

Landline number / Landlyn nommer

Mobile phone / Selfoonnommer *

Are you willing to do Volunteer Service? / Is u bereid om Vrywillige Diens te doen? *

In what capacity? / In watter hoedanigheid? (Max: 500)

Today's date / Vandag se datum

Acceptance / Aanvaarding

Digital confirmation and acceptance / Digitale bevestiging en aanvaarding

I confirm that all of the above details are true and correct. I also confirm that you may save my personal information for purposes of this membership application.

Ek bevestig dat bogenoemde inligting waar en korrek is. Ek bevestig ook dat my persoonlike inligting gestoor mag word vir die spesifieke doel van hierdie lidmaatskap aansoekvorm.

I agree / Ek aanvaar

INCOME	PRICE / MEAL
R5,000 or Less	R27
R5,001 or More	R60
Visitors	R65

Membership Application form

Digital confirmation and acceptance / Digitale bevestiging en aanvaarding

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