For office use only: Rec. No.

University Student: Yes No

Boat Number:

MEMBERSHIP APPLICATION 2023

Student Number Date of Birth Y Y Y Y M M D D

E-mail Address

Gender: Race: Black White Coloured other:

Surname
Initials Name
ID Nr. Nationality

Residence / PSO
Medical Aid Name
Medical Aid Number
Mobile Nr.
Parents Contact Info: F M

Study subject at SU (if applicable)

My Fees for 2023:

all prices incl. 15% VAT ZAR
RESIDENCE LEAGUE (BRONZE) R490

MOBILE ONLY (SILVER) R999

MOBILE, PC & CONSOLE (GOLD) R1700

TOTAL:

hereby declare that I will participate willingly and at own risk for the University of Stellenbosch, and in the case of an injury, accident or
any losses, I won’t hold the University, its workers or the sport club responsible for it.
I understand that the University is not responsible for any cost or complications with regard to sport injuries. The University won’t
negotiate with any medical doctors, dentists, etc. and won’t accept any responsibility for any accounts or expenses.

RESIGNATION:
If a member should decide to resign, then the resignation should be done in writing and presented to the Sport Manager and relevant
Coach. There will be a R200 non-refundable admin fee applicable should you wish to resign from the Club.

I hereby give permission that my membership fee of R…………. for 2023 can be deducted from my student account

Attached my membership fee of R……………. for 2023. Please note that all cash payments must be paid___________.

Bank: Standard Bank Stellenbosch

Name of Account: Stellenbosch University
Account Number: 07-300-6955
Branch Code: 05-06-10
Reference: student number (e.g. R5941 12345678)

Please send deposit slip or proof of payment to yaseeng@sun.ac.za

Signature: ………………………….… Date:…………………………………..