JOIN THE CLUB Name * First Name Last Name Email * Membership Options * - You are welcome to join in all the club activities such as regular Tuesday runs and Time Trials as well as our social events and long runs. - To qualify as a Junior you need to be 18 years old or younger on the 1st of January this year - If you have no requirement for an ASA Licence then join as a social member. Individual - R525 Family - R425 per member Junior - R225 Social Member - R250 Demographic Group * Black Coloured Indian White Age Category * Senior + Junior High School Primary School Gender * Male Female Prefer not to say Date Of Birth * MM DD YYYY Would you like to receive a happy birthday message on the Hout Bay Harriers WhatsApp Group? * Yes No Title * Mr Mrs Miss Dr Initials * What name do you prefer to be known by? * Type of ID * South African ID Passport Refugee Permit Birth Certificate Which Country Issued the passport? If using passport as ID ID Document or Passport Number * 2024 Licence Number If licensed runner last year Residential Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Postal Address If different to residential address Address 1 Address 2 City State/Province Zip/Postal Code Country Cell Phone number * Country (###) ### #### Occupation * Next of Kin Name * Next of Kin Relationship * Spouse Partner Sibling Parent Friend Next of Kin Contact Number * If you would you like to make a once off contribution to the club please indicate the amount below Throughout the year Hout Bay Harriers supports less privileged runners. Any contributions over and above our other fund raising initiatives will be appreciated and put to good use. Please select below I declare that I am a bona fide athlete / coach / technical official/office bearer. I confirm that all the information provided on this application is true and correct. I understand that my participation in an athletics related event is subject to the ASA Constitution, its rules and regulations. I understand that this licence can be retracted should I violate the ASA Constitution, its rules and regulations. I hereby accept that I participate in any event of ASA and its members entirely at my own risk. I indemnify ASA and its members, sponsors and organisers of any event against all and any action of whatever nature which may arise out of my participation and I agree that it is my responsibility to be medically fit to compete in any event. I understand that my information may be shared with ASA partners, in accordance with the ASA Privacy Policy. I understand that if I am a minor, my parent and/or legal guardian understands the nature of the athletic activity, approve of the declaration above, and sign it on my behalf I agree to the above I am a social member Payment Method Please make payment into the following bank account and email confirmation to houtbayharriers@gmail.com. Or Pay Via SnapScan Hout Bay Harriers Nedbank Account: 1676004262 Branch Code: 198765 Individual - R525 Family - R425 per member Junior - R225 Social - R250 EFT/ Bank Transfer SnapScan Thank you! Click to pay via SnapScan
