MCSA / MKSA

APPLICATION FOR MEMBERSHIP AANSOEK VIR LIDMAATSKAP National Secretary P.O. Box 3264 Cresta, 2118 Johannesburg Tel: 011 7911319 (o/h) Fax: 011 7911595(o/h) Cell: 083 307 8670 motorhome@telkomsa.net

Surname/Van *
First names/Voorname *
Title/Titel *
Nickname/Noemnaam
ID No / ID Nr. *
Spouse Name / Eggenote se naam *
Postal Address / Pos Adres *
Address

Address Line 2

City

Province

Postal Code

Country
Residential Address *
Address

Address Line 2

City

Province

Postal Code

Country
Phone / Foon *
Cell No / Sel Nr. *
Email / Epos *
Motorhome Details / Motorwoonwa Besonderhede
First Year of Manufacture *
Make *

Manufactured by ?
Model *
Regestration Number / Registrasienommer *
Accessories / Toebehore Awing Radio (Any Type) Airconditioner (Engine Driven) Airconditioner (Electrical Driven) Fitted Generator DSTV Decoder & TV
Comments / Remarks
Todays Date /Submission Date * / DD / MM YYYY
Motorhome Club of S.A, First National Bank, Northcliff Branch (IBT 253\705), A\C NO 62024701311. Membership Fees; Joining Fee R200.00 (two hundred rand) Annual Subscription R160.00 (One hundred and sixty rand) Total R360.00 This covers members from 1.7.2010 until 30.6.2011

Please pay application fee and forward proof of payment to the National Secretary. This is required before application can be approved. Thank You.
Type the letters you see in the image below.

MCSA / MKSA

MCSA / MKSA

Motorhome Details / Motorwoonwa Besonderhede

Motorhome Club of S.A, First National Bank, Northcliff Branch (IBT 253\705), A\C NO 62024701311. Membership Fees; Joining Fee R200.00 (two hundred rand) Annual Subscription R160.00 (One hundred and sixty rand) Total R360.00 This covers members from 1.7.2010 until 30.6.2011