Membership Application Form

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 :