BOKSBURG ATHLETIC CLUB Tel No : (011) 917-3721
P.O.BOX 17422, SUNWARD PARK, 1470 Fax No: 086 618 4488
Website: Email :
APPLICATION FOR 2015 MEMBERSHIP (MEMBERS DETAILS TO BE FILLED IN PLEASE)
DATE : ______MEMBERSHIP NO: ______
(To be filled in by the office)
2014 L/N.ISSUED : ______(IF APPLICABLE)2015 L/N ISSUED: ______
(If a 2014 licence number was issued to you please state number) (To be filled in by the office)
SURNAME :______MR/MRS/MS/MISS/MASTER (Please circle)
FIRST NAME :______
POSTAL ADDRESS : ______
______POST CODE : ______
PHYSICAL ADDRESS: ______
______POST CODE : ______
WORK TEL NO :CODE ( )______FAX NO.CODE:( )______
HOME TEL NO : CODE ( )______CELL NO : ______
EMERGENCY CONTACT NO : CODE ( ) ______NEXT OF KIN :______
(Please state name and surname)
EMAIL ADDRESS (PLEASE PRINT CLEARLY) ______
OCCUPATION : ______MALE / FEMALE______
IF YOU ARE A SCHOLAR :
STATESCHOOL YOU ATTEND AND GRADE YOU ARE IN:______GRADE______
IF APPLICABLE, NAME OF YOUR COACH AT BOKSBURG ATHLETIC CLUB : ______
IDENTITY NO : ______DATE OF BIRTH ______
AGE AS AT 01/01/2015 ______CHAMPIONCHIP NUMBER ______
T.SHIRT SIZE (ES,S,M,L,XL,XXL) [ ]SWEAT SHIRT SIZE (ES,S,M,L,XL,XXL,XXXL [ ]
YEAR THAT YOU JOINED BOKSBURG ATHLETIC CLUB : ______(THIS APPLIES TO CONTINUOUS MEMBERSHIP AT THE CLUB, IF YOU HAVE BROKEN MEMBERSHIP AND
REJOINED THEN YOU HAVE TO STATE THE YEAR THAT YOU REJOINED).
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PLEASE TICK RELEVANT BOXES
ACTIVITIES
ROAD RUNNING[] CROSS COUNTRY[ ]TRACK AND FIELD[]
WALKING [ ] TRI/BIATHLON[]CYCLING[]
(TRACK AND FIELD ATHLETES PLEASE ADVISE WHAT DISCIPLINES YOU TAKE PART IN E.G. JAVELIN
HURDLES, SPRINTS, HIGH JUMP ETC.) ______
OTHER SPORTS THAT YOU TAKE PART IN, PLEASE SPECIFY: E.G. TRAIL RUNNING, ORIENTEERING ETC.
______
CATEGORIES
Sub-Primary Youth()(U12) 11 yrs and younger on 31/12/2015
Primary Youth()(U14)13 yrs and younger on 31/12/2015
Sub Youth()(U17)16 yrs and younger on 31/12/2015
Youth()(U18) 17 yrs and younger on 31/12/2015
Sub-Junior()(U19) 18 yrs and younger on 31/12/2015
Junior()(U20) 19 yrs and younger on 31/12/2015
Senior()(20–39 yrs before 31/12/2015)
Veterans()(40-49 yrs before 31/12/2015)
Masters()(50-59 yrs before 31/12/2015)
Grandmasters()(60-69 yrs before 31/12/2015)
Great Grandmasters()70+yrs
Social Member ()29 years of age on 31/12/2015
Social Member()30 years of age on 31/12/2015 or older
PLEASE NOTE THAT SHOULD YOU DURING THE COURSE OF THE YEAR CHANGE YOUR CATEGORY (E.G. FROM VETERAN TO MASTER), YOU HAVE TO COMPETE AS A VETERAN UNTIL YOUR BIRTHDAY AND THEN ON THE DAY OF YOUR BIRTHDAY YOU WILL THEN COMPETE ASA MASTER.
A COPY OF YOUR IDENTITY DOCUMENT/BIRTH CERTIFICATE MUST ACCOMPANY YOUR APPLICATION. THIS APPLIES TO ALL MEMBERS. YOUR CO-OPERATION IN THIS REGARD WILL BE GREATLY APPRECIATED. IF YOU HAVE SUPPLIED THE OFFICE WITH A COPY OF YOUR I.D. DOCUMENT ETC PLEASE IGNORE. (ALL AGE GROUPS ALL CATEGORIES)
I HEREBY APPLY FOR MEMBERSHIP AND DECLARE THAT I AM AN AMATEUR ACCORDING TO THE DEFINITION LAID DOWN BY ATHLETICS SOUTH AFRICA.
SIGNATURE OF APPLICANT : ______
SIGNATURE OF PARENT : ______
(If Athlete is Under 18)
IN THE EVENT OF NEW MEMBERS TRANSFERRING FROM ANOTHER CLUB
PREVIOUS CLUB : ______
CLEARANCE LETTER RECEIVED : ______
ACCEPTANCE OF MEMBERSHIP IS SUBJECT TO THE COMMITTEE APPROVAL.
FOR OFFICE USE: DBASE ( ) EMAIL ( ) SMS ( ) C.G.A. ( )