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SHA Membership Application form

AANSOEK OM LIDMAATSKAP

APPLICATION FOR MEMBERSHIP

Name (Mr. Mrs. Ms):

Naam (Mnr. Mev. Mej.):……………………………………………………………………………………………

……………………………………………………………………………………………………………………………

(If applying for couple membership, please provide both names)

(Indien aansoek gedoen word vir lidmaatskap van ‘n paartjie verskaf asseblief beide name)

Street address:

Straatadres: …………………………………………………………………………………………………………..

……………………………………………………………………………….. Code / Kode ………………………..

P O Box

Posbus……………………………………………………………………… Code / Kode ………………………..

E-mail / E-pos: ………………………………………………………………………………………………………

Telephone:

Telefoon:…………………………………………………. (W)   ………………………………………………. (H)

Cell:                                                               Fax : 

Sel:……………………………………………………… Faks: ……………………………………………………..

Signature:

Handtekening: ………………………………………………………….. Date / Datum…………………………

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Membership fees (R 65,00 per person) for the 2020 / 2021 financial year can be paid into the following account

Lidmaatskapgeld (R65,00 per persoon) vir die 2019 / 2020) finansiële jaar kan in die volgende rekening inbetaal word

(The financial year runs from 1 April to 31 March / Die finansiëlejaar strek vanaf 1 April to 31 Maart)

Nedbank Swellendam

Branch / Tak 19876500

Swellendam Heritage Association / Swellendam Ervenisvereniging

Rekening Nr / Account Nbr 1118273125

Please enter your surname as reference.

Meld asseblief u van as verwysing.

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Date application received: ……………………………………….. Applicant informed: ………………………………………………. Data base entry:   Signed – Secretary: