BOAT RACK – NON MEMBER 2015 ‐ 2016 REGISTRATION NUMBER _____________ SURNAME______________________________________ INITIALS _________ NAME BY WHICH CALLED________________________________________ OCCUPATION ID NUMBER __________________________ ______________________________________ ADDRESS MALE____ FEMALE_____ ______________________________ ______________________________ ______________________________ ______________________________ ______________________________ CLUB__________________________ DATE OF BIRTH_______________________ RE‐REGISTRATION______ NEW MEMBER______ TELEPHONE/H_____________________ TELEPHONE/W_______________________ FAX______________________________ CELL PHONE_________________________ E‐MAIL_________________________________(important as all correspondence is through e‐mail) ____________________________________ ____________________________________ SIGNATURE SIGNATURE OF MINOR’S PARENT ____________________________________ ____________________________________ CLUB OFFICIAL AS WITNESS DATE THE FOLLOWING FEES MUST ACCOMPANY THE REGISTRATION FORM: BANK DETAILS: NATAL CANOE CLUB, NEDBANK 1340277050, HAYFIELDS 134025 KINDLY RETURN OR FAX REG FORM TOGETHER WITH PROOF OF PAYMENT – 033 3421525 please tick appropriate box BOAT RACK FEES TOTAL FEES PAID TO NCC SENIORS R 380.00 JUNIORS R 380.00 BOAT RACK NUMBERS________________________________________________ Tel: 033 3421528 Fax: 033 3421525 info@dusi.org.za