CKNRAC

Membership Application Form


Please fill in your details here:
Items marked with a * are required fields
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:
R300 per month
(please answer yes or no)
Patrol member
R300 per month

(please answer yes or no)

Businesses in the area:
R350 per month
(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)

Notifications:

Would you like to receive regular email updates?

(please answer yes or no)
Would you like to be added to a WhatsApp group?
(please answer yes or no)

Once proof of payment has been received you will be added to the respective lists.


Name and phone number of people to be added

   

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.