Application Form for Juniors (14 to 18 years)

APPLICATION FORM FOR JUNIOR MEMBERSHIP - 14 to 18 years of age

NB: active players are not eligible for membership!
Date format is dd/mm/yyyy.

Surname (required)

First name (required)

ID number (required)

Date of birth (required)

Race/Ethnicity (required)

Language (required)
AfrikaansEnglishXhosaOther

Contact number (required)

Your Email (required)

Confirm Email (required)

Postal/Contact address (required)

School attending (required)

Current grade (required)

Next of kin (required)

Relationship to kin (required)

Contact number of kin (required)

BokSmart number

Expiry date

Did you do a level 1 course?
YesNo

Have you reffed before?
YesNo

Are you prepared to referee anywhere in the Western Province?
YesNo

What is your mode of transport? (eg. public or private) (required)

By submitting this form, you certify that the information contained herein is true and correct as well as the following:

I hereby undertake to be a devoted and disciplined member of the Society and to subject myself to the Constitution and Bye-laws of the Society as legally amended from time to time.

I have read and agree to the above information