CKNRAC

Membership Application Form

Please fill in your details here:
 
Title
Initials
First Name
Surname
Street Number and Name
Home telephone
Work telephone
Cellphone
Fax
EMail Address
Husband's Occupation
Wife's Occupation
Please indicate an area you wish to assist with:
 
Street Helper             (please answer yes or no)
Area Patrols              (please answer yes or no)
Domestic  Watch      (please answer yes or no)
Other                           (give details)
Membership options:
 
Non patrol members:
Once off joining fee of R40
R100 per month 		(please answer yes or no)
Patrol member
No Joining Fee
R100 per month

(please answer yes or no)

Businesses in the area:
Joining fee of R40
R100 per month 		(please answer yes or no)
Are you contributing to the CPF?
(please answer yes or no)
Are you running a business from home ?
(please answer yes or no)
Do you need an invoice?
(please answer yes or no)
Do you need a receipt?
(please answer yes or no)

BANKING DETAILS
Please give your name and street address as reference
when paying by direct deposit.

CKNRAC
Bank: ABSA
Branch: Clearwater
Account No: 730 172 885
THANK YOU!   YOUR SUPPORT IS APPRECIATED.