|
Last name
|
|
|
|
|
|
| First names |
|
|
| Title |
|
|
|
|
|
|
Tel No (No gaps between num)
|
|
|
|
|
|
Cel No (no gaps between num)
|
|
| Email address |
|
| Fax No (No gaps between Num) |
|
| Establishment name |
|
| Category |
|
| Web site |
|
| Establishments physical addr |
|
| |
|
| |
|
| Postal code |
|
| Province/County |
|
| Country |
|
|
Months you are prepared to take bookings:
|
|
|
|
|
| Brief description of premises |
|
| Subscription Paid - direct banking
(details below) |
Place a tick in the box if payment made
|
|
Date payment made
|
|
| Subscription amount : |
South Africa - 280.00 Rands per annum
|
| I have read,understood
and agree to abide by: |
The "Agreement & Code of Practice"
|