Born2Run Athletics Club Membership Form

Transcription

Born2Run Athletics Club Membership Form
Born2Run Athletics Club Membership Form
FULL NAME
IDENTITY NUMBER
AGE
SEX
OCCUPATION
CELL NUMBER
EMAIL ADDRESS
PHYSICAL / POSTAL ADDRESS
What size Born 2 Run Club vest do
you require?
⃝ S
Would you like to order a Born 2 Run
Club peak? (R130 ea)
⃝ M
⃝
⃝ L
YES
⃝ XL
⃝ Grey
⃝ XXL
NO
⃝
White
⃝
Would you like to order a PUMA
Ladies Club t-shirt? (R300 ea)
⃝ S
⃝ M
⃝ L
⃝ XL
⃝ XXL
Would you like to order a PUMA Men’s
Club t-shirt? (R300 ea)
⃝ S
⃝ M
⃝ L
⃝ XL
⃝ XXL
Would you like to order a PUMA
beanie? (R110 ea)
⃝
YES
⃝
NO
Would you like to be added to the
club mailing list?
⃝
YES
⃝
NO
Did you belong to a different running
club in 2014? If so, please provide a
clearance letter.
⃝
YES
⃝
NO
Do you follow Born 2 Run AC on
twitter? @born2runac
⃝
YES
⃝
NO
Do you follow Born 2 Run AC on
facebook?
⃝
YES
⃝
NO
Are you registered with parkrun SA?
⃝
YES
⃝
NO
Have you registered with ASA online?
⃝
YES
⃝
NO
FEES
⃝
⃝
Please deposit fees via EFT into the
following account:
⃝
⃝
⃝
R500
R300
R300
R130
R110
Early Bird Joining Fee
Ladies Club tee
Mens Club tee
Club Peak
PUMA Beanie
Born 2 Run Athletics Club
First National Bank
TOTAL PAYABLE
Acc No. 62468178580
R_____________________
Branch. 220725 (Howick)
Reference: Surname, Fees
PLEASE ATTACH PROOF OF PAYMENT
Membership to Born 2 Run Athletics Club
entitles you to a 20% discount on all
Puma active and casual wear sold at
retail outlets throughout South Africa.
Simply take proof of identification with
you when you visit your local Puma Retail
Store.
Please return this form, a completed ASA licence form and POP
to Ann at [email protected]
We look forward to running with you!
Born 2 Run AC Membership Fees (2015)
Early Bird Joining Fee (October 2014 to end November 2014): R500
Annual Membership Fee (December 2014 onwards): R700