Four Wheel Drive Club of Southern Africa
(Western Cape)
Application for Membership 2017
Please complete the details by typing in the grey areas and emailing the completed document to the Club Membership
Administrator at [email protected].
You can also print out this document, complete by hand and fax to 021 853 2245 or fax to e-mail 086 613 3515.
Member
Surname:
Name:
Preferred Name:
Occupation:
ID Number:
Date of Birth:
(dd/mm/yyyy)
Home/First Language:
Second Language:
Email Address:
Cellphone:
Receive SMSes?:
Occasionally the Club will send notices via SMS. Untick if you do NOT want to receive SMSes
Home Telephone:
Work Telephone:
Home Fax:
Work Fax:
Residential Address:
Postal Code:
Postal Address:
Postal Code:
ApplicationForm/2017/01/01
Spouse/Partner
Name:
Preferred Name:
Date of Birth:
(dd/mm/yyyy)
Email Address:
Receive Club Emails?
Tick for spouse/partner to receive club emails as well.
Children
Child’s Name:
DOB:
(dd/mm/yyyy)
M
F
Child’s Name:
DOB:
(dd/mm/yyyy)
M
F
Child’s Name:
DOB:
(dd/mm/yyyy)
M
F
Child’s Name:
DOB:
(dd/mm/yyyy)
M
F
Driving Experience
How many years have you had a motor vehicle license:
How many years have you owned an off-road vehicle:
Estimate how many off-road kilometres you have done:
How do you rate yourself:
Novice
Competent
Experienced
Which of the following would you prefer to avoid:
Thick sand
Mud
Water
Rocks
Steep slope
Thick bush
Would you or your partner want to complete Club Driver
training:
Self
Partner
Vehicle Details
Make:
Model:
Year:
Type/Series:
Colour:
Reg No:
ApplicationForm/2017/01/01
What Interests You
Day Runs
Self
Partner
Self
Partner
Recognized 4x4 trails:
Scenic back road trips:
Weekend Runs:
Safaris (several days and 1000’s of kms):
4x4 Challenges
Participant (Club Points Events):
Marshal:
Which of the following Sections of the Club will you support
Outings
Recce trails and organize Club run:
Conservation
Volunteer your services to assist with
conservation projects:
ORRU
Volunteer your services to the Off-Road Rescue
Unit and assist in disasters or search and rescue:
Social
Assist with organizing Club social events:
Administration
Utilitising your skill to assist in running the Club:
Briefly mention how you heard about the Club:
ApplicationForm/2017/01/01
MEMBERSHIP FEES 2017
Initial Joining Fee:
R 150
Annual Fee:
R 450
A Country Membership is available if you live far from Cape Town. Please discuss with
the membership administrator ([email protected]) if you think you qualify.
TOTAL
R
Please add up the amounts and enter the total here
Example: R150 + R450
I undertake to abide by the rules of the Four Wheel Drive Club of Southern Africa (Western Cape) as laid down in the
Club’s constitution and acknowledge that I participate in the Club’s activities at my own risk.
I Accept
If you have printed and completed this form by hand please sign: _______________________
I will be paying my membership fees by:
Cheque
Electronic Transfer
Cash
Bank Account Details
Account Holder:
Four Wheel Drive Club
Bank:
Nedbank, Somerset West
Branch Code:
106012
Account Number:
1060059223
Account Type:
Cheque/Current
Please note that full membership is subject to confirmation after a probationary
period of three (3) outings as a driver and completion of the Club’s driver training.
ApplicationForm/2017/01/01