Clarens Sector Police Forum – Membership Form

CLARENS SECTOR POLICE FORUM

 

I would like to sign up as a member of the policing forum.  Please send a monthly invoice to the e-mail address listed below.  I have noted the bank details and will pay by EFT, stop order or cash and will use the account number allocated to me as a bank reference.

 

NAME:…………………………………………………………………………………

 

ADDRESS:………………………………………………………………………………………………..

 

CELL………………………………….

 

E-MAIL ……………………………………………………………………………………………………

 

PERMANENT RESIDENT:YES/NO……

 

I shall be making ONE of the following contributions: (tick)

 

BUSINESS: (R250 p.m.)                                 ____

B&B or SELF CATERING:  (R200 p.m.)        ____

RESIDENTIAL:  (R100 p.m.)                                      ____

 

METHOD OF PAYMENT: (EFT / Stop Order / Cash)………………………………..

 

BENEFICIARY BANKING DETAILS:

 

POLICE FORUM TRUST,   ABSA Bethlehem (632005),   Acc No 927 449 0569

 

 

 

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Signature of new member

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References:  Johann Lehman      083 447 9925                        Les Thake                 082 492 2482

Deon Spruyt             083 782 1940                        Randall Poultney     084 811 2842