Membership Application Form

Cape Bird Club and BirdLife South Africa

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Payment must be made by EFT or Direct Deposit into BIRDLIFE SOUTH AFRICA’s bank account,
see details below.

Completed application form and proof of payment to be POSTED TO:
Cape Bird ClubMembership, P.O.Box 2113, Clareinch, 7740.

Membership is for a period of 12 months from the date of joining and renewable each year.

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Personal Detail

Title: Prof/Dr/Mr/Mrs/Ms/Miss Initials: Language:  Eng / Afrik
Name: Date of Birth:      /      /
Surname:
Postal Address:
Postal code:
Tel Home: Tel Work:
Fax:
Cell:
Email:

Membership Detail

Membership fee includes both BirdLife South Africa and the Cape Bird Club membership.

Club Individual Senior Citizen Student Amount Paid
Cape Bird Club R240 R180 R180

R

BLSA (optional) R225 R100 R100

R

Senior Citizens: 60 years and older.  Student: 17 years and younger or over 18 and in full time study.

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Family Members Detail

Family Member Title Name Surname Date of birth Fee

Amount paid

Spouse / Partner . . .     /       / R85 R
Child 1 . . .     /       / R25 R
Child 2 . . .     /       / R25 R

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Total amount remitted

Cape Bird Club fees . R
Family Members fees . R
BirdLife South Africa fees (optional) . R
Magazine African Birding    (6 issues p.a.) optional
BLSA members R228.00   /  Non BLSA members  R288.00
. R
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Total amount paid

R

Payments should be made to BIRDLIFE South Africa: Bank Account No: 620 6750 6281, FNB,
Randburg
Branch Code 25 40 05.      Attach proof of payment to application form.

Credit Card Payment

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Expiry date:       /            CVC No. Visa/Master           Diners     X        Amex    X
Name of Card holder: Signature:

                                     Membership rates are valid until 30 June 2016.

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