PLEASE MAIL REGISTRATION FORM TO: and proof of payment to EKURHULENI : REGISTRATION / AFFILIATION FORM 2018 FEE : R250-00 per player Please note players must pay their affiliation fee before 15 March 2018 Boys U/8 U/10 U/12 U/14 U/16 U/18 U/20 2018 2011/2012/2013 2009/2010 2007/2008 2005/2006 2003/2004 2001/2002 1999/2000 Age Group Girls U/8 U/10 U/12 U/14 U/16 U/18 U/20 2011/2012/2013 2009/2010 2007/2008 2005/2006 2003/2004 2001/2002 1999/2000 Name of Player Surname First Name Date of Birth Identity Number E-mail address School Club Home Tel Player Cell # Mom Cell # Dad Cell # Contact Info Mom Work # Work Dad # Mom Name Dad Name Name of medical aid: Medical Aid number: Medical Information: Medical aid? Main member of medical aid: Yes No Registration fee of R250.00 for 2018 must be deposited into the following account. East Gauteng Junior Chess Association ABSA Acc no 4050675403. Branch Code: 630542 Ref: Reg and name and surname I hereby acknowledge that I have read and taken notice of the selection criteria attached to this document and that I fully understand the content thereof. Signed: Date Parent /Guardian:
PLEASE MAIL REGISTRATION FORM TO: and proof of payment to EKURHULENI : REGISTRATION / AFFILIATION FORM 2018 FEE : R250-00 per player Please note players must pay their affiliation fee before 15 March 2018 2018 Age Group Boys U/8 U/10 U/12 U/14 U/16 U/18 U/20 2011/2012/2013 2009/2010 2007/2008 2005/2006 2003/2004 2001/2002 1999/2000 Girls U/8 U/10 U/12 U/14 U/16 U/18 U/20 2011/2012/2013 2009/2010 2007/2008 2005/2006 2003/2004 2001/2002 1999/2000 Name of Player Surname First Name Date of Birth Identity Number E-mail address School Club Contact Info Home Tel Player Cell # Mom Cell # Dad Cell # Mom Work # Work Dad # Mom Name Dad Name Medical Information: Medical aid? Yes No Name of medical aid: Medical Aid number: Main member of medical aid: Registration fee of R250.00 for 2018 must be deposited into the following account. East Gauteng Junior Chess Association ABSA Acc no 4050675403. Branch Code: 630542 Ref: Reg and name and surname I hereby acknowledge that I have read and taken notice of the selection criteria attached to this document and that I fully understand the content thereof. Signed: Parent /Guardian: Date
Blank-Registration-form-2018.docx