Nonprofit Registration No: 001-298 NPO

Public Benefit Organisation Exemption No: 930 004518

BirdLife South Africa Birder Friendly Establishment Programme

Application Form 2016/17

Contact Details

Name of Enterprise
VAT Registration Number
Name of contact person
Designation of contact person
Physical Address
Postal address
Telephone number
Cellular Number *for two free bird call ringtones as per membership benefits
Facsimile Number
Email Address
Website Address
GPS Co-ordinates
Name of contact person for reservations

Accommodation category: Tick appropriate box

Hotel / Lodge / Guest House / B&B / Self Catering / Other
(e.g. camping)

If other, please give details: ______

Please indicate the different rates for above mentioned accommodation:

______

______

Accommodation Grading

Does your enterprise enjoy an official grading status? If so, please specify:

Particulars of Amenities and Facilities

Rooms Serviced daily / Wheel Chair Friendly facilities available
Pets allowed / Internet facilities available
Cell phone coverage available / 4X4 vehicle necessary for access
Quad Bike trails
(establishments with uncontrolled recreational quad bike trails will not be able to qualify for Birder-friendly status) / Restaurant and Bar facilities on site
Take away facilities on site / Petrol facilities on site
Distance to closest town (ATM/Doctor/Shop)? / Distance to closest restaurant/take away
Credit Card Facilities available on site
Check In time / Check Out time
Directions
Deposit Policy / Cancellation Policy

Birding information and proximity to birding sites of significance

Do you have birding infrastructure on your property? If so please give details (e.g. walking trails, hides etc)
Nearest birding site (e.g. Important Bird Area, game reserves, wetlands, forests, grasslands etc)
What bird specials occur in your area?

Joining fee

Joining Fee and annual renewal thereafter (South Africa): / R1 135.00
Joining Fee and annual renewal thereafter (SADC countries): / R1605.00

*wet June 2016

** This includes an annual subscription to African BirdLife magazine

Commitment

I wish to participate in the BirdLife South Africa “Birder Friendly Establishment” initiative and would like BirdLife South Africa to consider my self-assessment form (attached) for this purpose. I understand that BirdLife South Africa reserves the right in its absolute discretion to refuse to accept this application and to require any establishment or enterprise to cease using the BirdLife branding in any form whatsoever.

Payment procedures

No payment should accompany this form. On receipt of the completed Application and Self Assessment Forms, BirdLife South Africa will assess the application. On approval, a Tax Invoice will be sent and upon receipt of payment, the membership will be processed accordingly.

Information Supplied By:

Name:
Designation:
Date:

Please return the completed forms to:

Natasja Retief

EMAIL: OR FAX: 086 511 5171

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