COASTAL MEMBERSHIP APPLICATION

First Name *

Surname *

Title (Mr / Mrs / Miss)

I.D. Number/Date of Birth *

Telephone Business (include code)

Telephone Home (include code)

Cell Number *

Email Address *

Residential Address *

Province *

Name of Previous Club

Srixon Handicap Card / SA Player ID (if already handicapped)

Where did you hear about our coastal membership? *

If a publication, which one?

Your payment of R930 can be made via E.F.T. (electronic funds transfer) into the following account:

Account: Port Shepstone Country Club

Bank: First National Bank

Account Number: 62931427430

Branch: 250655

Reference: Your Name and Surname Please.

KINDLY NOTE THAT YOU WILL NOT BE ABLE TO SUBMIT THIS APPLICATION UNLESS YOU ATTACH YOUR PROOF OF PAYMENT USING THE BUTTON BELOW.

Please attach proof of payment. *