MIDRAND CHESS CLUB
The House of Chess in Midrand
Kris Eale
Midrand Chess Club
Mobile: +27 846 50 79 89
Email:[email protected]
www.midrandchessclub.com
Old Pretoria Main Road
Midrand business park,
Halfway, Midrand 1686
Johannesburg, South Africa
________________________________________________________________________________
MIDRAND CHESS CLUB MEMBERSHIP APPLICATION FORM
APPLICANT INFORMATION
Surname and First names:
Physical Current address:
Suburb:
Province:
Postal Code:
Suburb:
Province:
Postal Code:
Date of Birth:
Age:
Sex:
Postal address:
IF UNDER 18 PARENT INFORMATION
Surname and First names:
Physical address:
Suburb:
E-mail:
Relationship with the child:
ID No:
Province:
Postal Code:
Cell
Phone:
MEMBERSHIP INFORMATION
PLEASE SELECT THE TYPE OF MEMBERSHIP SUITABLE FOR YOU
Chess Player Promotion: End 30th October
2013: R150
Family Membership Promotion:
Chess Player Adult:
R400
Chess Player Child : R200
R250
Chess Coach Promotion
R150
Family Membership
(for 2 parents +2
Children):
R600
Free Membership:
Chess Coach R300: Senior Members
only



Child under 7
Private Lessons
School Lessons
AGREEMENT (BY ADULTS AND GUARDIANS)
I ……………………………………………………………………………., I would like to confirm that I am applying for a membership as mentioned
above to the Midrand Chess Club (MCC) and I agree to comply with the MCC rules of fraternity, respect and Fair Game. 1
1.
Please check one below:
_____ New Members: If you are applying for membership, you may send your complet ed registration via email, make deposit to the bank
account and send the proof of payment : [email protected] . Once your registration is received, you will be contacted by the MCC
within 7-10 days.
How did you find out about us? ____________________________________________________
_____ Current Members: If you are renewing your membership, please send your completed registration form and membership fee payment to
the same address.
Membership fees are payable by cash at the weekend playground or deposit on our provisionary account:
______if you want to receive our newsletter via email (Yes/No)
2.
Member card can be collected by request on the weekend pl ayground
3.
The Membership fees include free Coaching for Kids 2
4.
Details:

Bank details: Fist National bank, Account: 62210423571: type Cheque : Account Holder: Mr KE.EALE branch code: 254805

Physical Address: Halfway House library Midrand Business Park

Mobile: +27 84 650 79 89
Email: [email protected]
Signature of applicant (If older than 17)
Date
Signature of co-applicant, if for family membership
Date
We look forward to welcoming you and your family to the Midrand Chess Club.
Midrand Chess Club,www.midrandchessclub.com /Midrand Business Park: Midrand Library: +27 84 650 79 89
Midrand Chess Club, www.midrandchessclub.com/Midrand Business Park: Midrand Library: +27 84 650 79 89