Membership form - The Cape Bird Club

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
Total fees	R370	R200	R200

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

Family Members Detail

Family Member	Title	Name	Surname	Date of birth	Fee	Amount paid
Spouse / Partner	.	.	.	/ /	R80	R
Child 1	.	.	.	/ /	R25	R
Child 2	.	.	.	/ /	R25	R

Total amount remitted

BLSA and Cape Bird Club fees	.	R
Family Members fees	.	R
Magazine subscriptions (optional)	.	.
BirdLife South Africa's magazine African Birding (6 issues p.a.)	R205	R
.	Total amount remitted	R

Cheques should be non transferable and made payable to BirdLife South Africa.

Credit Card Payment

–

Expiry date: / CVC No.

Visa/Master X Diners X Amex X

Name of Card holder:

Signature:

Club membership rates are valid until 30 June 2013. Rates applicable in South Africa.
Other enquiries to membership@birdlife.org.za

Direct Bank Deposit

Bank	Bank Branch	Account Name	Account Number	Branch Code
FNB	Randburg, JHB	BirdLife South Africa	620 6750 6281	25 40 05

Remember to attach the Deposit slip as proof of payment with the Application form, when posting your
membership application to the Membership Secretary at the address above.