WELCOME To Our Site.
 

KINDLY COMPLETE FORM AND FAX TO 086 511 2911

SOUTH AFRICAN TRANSPLANT SPORTS ASSOCIATION
MEMBERSHIP APPLICATION FORM

PERSONAL DETAILS
Title:  
Surname:  
First Name:  
Date of birth:                       
Postal Address:
City:
Postal Code:
Province:
Tel. Home:
Fax. Home:
Email Home:
Mobile:

WORK DETAILS
Employed Full-Time Employed Part-Time Unemployed
Student Retired Homemaker
Tel. Work:
Fax. Work:
Email Work:

CATEGORY MEMBERSHIP
Transplantee Spouse/Family Member Donor Donor Family

INDIVIDUAL:

 Professional Corporate Friend Of Transplantee

TRANSPLANTATION HISTORY
Organ/s:
Date:
Hospital:

PARTICIPATION IN SOCIETY ACTIVITIES

Transplant Games: Please indicate your sporting interest:
Swimming Golf Lawn Bowls Badminton
Table Tennis Tennis Squash Cycling
Road Running Volley Ball Track/Field (Specify)   
Other (Specify) 
Interested to be a sponsor:
 
NO MEMBERSHIP FEE PAYABLE Membership renewable on 31st March of every year.
   
DONATIONS WILL BE APPRECIATED

I include a donation of R…………………
   
Bank Deposit Postal Order Cheque Electronic Transfer


Bank deposits and electronic transfers:  Fax proof of payment
 
Bank Details: ABSA Name of account: SATSA National (Cheque)
Branch: Tygervalley Branch Code: 632005
Account Number: 4067461041 Reference: Your name

NO MEMBERSHIP FEE

Other:

Donation :
TOTAL:

Payment Method:

Bank Deposit Postal Order Cheque Electronic Transfer

Cheques and Postal Orders:

 Should be crossed and made payable to  the:
SOUTH AFRICAN TRANSPLANT SPORTS ASSOCIATION

 

Bank Deposits & Elec. Trf's: 

 Post, Fax or email proof of payment:
Postal: PO Box 577, St Francis Bay 6312
Fax: 086 511 2911 ~ Email: info@transplantsports.co.za

Banking details:             
Name of account: 

Branch
Code:

Account number:   
     Reference: 


ABSA
SATSA National (Cheque)
Tygervalley


632005

4067461041
Your name