| MEMBERSHIP INFORMATION | ||||||
| Full Names | ||||||
| Surname | ||||||
| ID Number | ||||||
| Physical Address | Postal Code | |||||
| Postal Address | Postal Code | |||||
| Tel. Nr | Celphone Nr. | |||||
| Fax Nr. | E-mail address | |||||
| Wife’s Name | ||||||
| Birds kept: | (Just type Y or N) | |||||
| Parrots | Y / N | Ringnecks | Y / N | |||
| Parakeets | Y / N | Cites 1 | Y / N | |||
| Finches | Y / N | Other : | ||||
| Water fowls | Y / N | |||||
| Club Fee (Annual) : | R 250.00 | PASA Number : | ||||
| PASA Fee : (Once Off Registration) | R 50.00 | |||||
| PASA Fee (Annual) : | R 125.00 | |||||
| For Office Use Only | ||||||
| Membership Approved : | Date Joined : | |||||
| Club Number : | TOTAL Received : | Receipt Number : | ||||
| PASA Number : | ||||||
| Renewal Information : | ||||||
| Date : | Receipt Nr : | Amt Received : | Date : | Receipt Nr : | Amt Received : | |
Membership Application Form
