Mountain Club of South Africa KwaZulu-Natal Section
FOR OFFICE USE ONLY PRINT YOUR NAME on the back of your photos - and Prestik here
P.O. Box 50649, Musgrave 4062, DURBAN Email:
[email protected] Website: http://kzn.mcsa.org.za Bank a/c: Standard Bank, Musgrave Rd, Durban A/c No: 051 207 141 Branch Code: 042626
Entrance Fee Paid Subscriptions Paid Category Membership Number
DO NOT STAPLE
Circulars Journal Date card posted
Application for Membership - 2018 Please complete and email or post this application with your photos and payment/proof of payment. Category of membership sought: (Fees applicable for period 1/1/2018 to 31/12/2018). Tick where applicable. Category
Fee
Ordinary Single (OM) Ordinary Joint
Tick one
Category
Fee
R 490
Student Member (18-25yrs) (SM)
R 125
(OJ)
R 340
Junior Member (13-17yrs)
R 125
Country Single
(CM)
R 310
Family Member (up to 13yrs) (FM)
Free
Country Joint
(CJ)
R 250
Entrance Fee
R 80
(JM)
Tick one
Applicants for Ordinary or Country membership must be at least 17 years of age. Applicants for joint membership categories must submit a separate form in respect of each partner. Country membership applies to those living outside the metropolitan areas of KwaZulu-Natal, or who are also members of another MCSA section. They do not receive a journal. If a journal is required, full membership must be applied for. Family members must be children of current KZN Section members and under 13 years old. Applicants for Junior membership must be between 13 and 17 years of age. This form must be signed by a parent or guardian of applicant - for Family or Junior membership. Applicants for Student membership must be bona fide students at a tertiary institution; and 18 to 25 years of age.
Date of Application: ………./………/……….
Sex: ☐ M / ☐ F
Occupation: ....................................…………………………………..…
Date of Birth: ………./………/………. Title and Initials: ………………..…………………………………..
Full Names: …………………………………………………….……………………………………………………………………………………………………..…………….... Postal Address: …………………………………………………………………………….……………………………………………………………………...................... ………………………………………………………………………………………………………… Phone # Home: ………………………………..…….………………….
Post code: …………………………………….. Work/Cell: ……………………………………………………………
E-mail Address: ………………………………………………………………………………………………………………………………………..…………..….……………. In terms of the constitution, the proposer and seconder must be members of at least two years’ standing. If neither is a committee member, then the supporting signature must be that of a committee member. Proposer: ………………………………………….………..…….
Seconder: ………..…………………………………………………………….
Additional signature in support : 1. ……………………………………………………………… I enclose R __________ being my entrance fee and subscription for the current year, and two 30 x 30 mm passport photographs (B&W or colour) for my membership card (or good quality digital images thereof). (PRINT YOUR NAME on the back of your photos) N.B. The entrance fee is waived for members of other MCSA sections, members of the University of Natal mountain clubs, Technikon mountain club, school climbing clubs and student, junior and family members. In the event of an application being rejected, all monies will be refunded.
FEES PAID: Entrance Fee: R………….. Subscription: R………….. TOTAL: R………..… Method of payment: EFT / Cheque / Cash
I hereby agree to abide by the rules and constitution of the club:
_____________________________
_________________________________
Signature of applicant
Signature of parent / guardian (if applicable)
FOR COMMITTEE USE ONLY: Application presented to the Committee on: ………./………/………. and approved. Chairperson: ………………………………………………………………………..
