Fynbos Membership Application Form

Surname / Van *

Name / Naam *

Identity number / Identiteitsnommer *

Date of birth / Geboortedatum *

Language / Taal *
—Please choose an option—EnglishAfrikaansOther / Ander

Marital status / Huwelikstatus *
—Please choose an option—Married / GetroudWidower / WewenaarWidow / WeduweeUnmarried / Ongetroud

Gender / Geslag *
—Please choose an option—Male / ManlikFemale / Vroulik

Church affiliation / Kerkverband *

Profession with retirement / Beroep met aftrede *

Household / Huishouding *
—Please choose an option—Spouse / Eggenoot(te)Live alone / Woon alleenLive with other elderly / Woon saam ander bejaardesLive with family / Woon saam familieLive with other / Woon met ander

Has your financial position changed in the last 5 years? / Het u finansiële posisie in die laaste 5 jaar verander? *
—Please choose an option—Yes / JaNo / Nee

Monthly income / Maandelikse inkomste *
—Please choose an option—R0-R1,950R1,951-R2,150R2,151-R2,800R2,801-R3,500R3,501-R5,000R5,001-R7,000R7,001-R9,999R10,000+

Are you willing to do Volunteer Service? / Is u bereid om Vrywillige Diens te doen? *
—Please choose an option—Yes / JaNo / Nee

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

Today's date / Vandag se datum