Membership Application Form

Cape Bird Club and BirdLife South Africa

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.
or faxed to: 021 530 4435 or e-mailed to: ackroyd,joan@broadwalk-mews.co.za

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 R255 R190 R190

R

BLSA (optional) R240 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 . . .     /       / R90 R
Child 1 . . .     /       / Free R
Child 2 . . .     /       / Free 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 R235.00   /  Non BLSA members  R288.00
. R
.

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 2017.