BORDER OUTDOOR ADVENTURE ASSOCIATION

Membership Application / Renewal

Membership From 1St January, 2009

PLEASE COMPLETE ALL DETAILS                                                                                 

SURNAME:

 

FIRST NAME:

 

Name of Spouse:

 

Names of Children(U16):

 

 

 

 

 

 

 

 

 

 

 

Residential Address:

 

 

 

 

 

 

 

Code:

Postal Address:

 

 

 

Code:

E – Mail Address:

 

Test E – Mail:

Please e-mail to: mervynhiking@absamail.co.za

 

Telephone No’s:

Home:

Bus:

Cell:

 

 

 

 

 

 

MEMBERSHIP CATEGORY:

ANNUAL

HALF-YEAR

  Amount

Ordinary Single Membership

   R100

    R50

 

Ordinary Family Membership

   R100

    R50

 

Scholar Under 16

   R50

    R25

 

Affiliate – Scholastic / Religious

   R100

    R50

 

Associate - Corporate/ Sporting /Assoc

   R150

    R75

 

Total Paid:

Cheque

 

Cash

 

 

 

R

 

 

 

 

 

 

Payment Details: Cheques Payable To: Border Outdoor Adventure Association         Not Transferable                                          

Post to:                      The Treasurer,  BOAA,  P O Box 2278,  Beacon Bay, 5205

Banking Details For Direct Deposits:  A B S A Bank –  East London             Branch No: 630 121  

Account No:      071 236 6893                                                                             NB: Please Send Details Of Direct Deposits

Fees may also be handed in at: The Portside Inn,  11 Currie Street, Quigney, E. L. NB: Exact Amount

 

 

 

 

 

I/We* agree to be bound by the Constitution of the BOAA and any Rules and Regulations that are introduced in terms of the Constitution.

Members Signature:…………………………………Spouse’s Signature:………………………………

Date:……………………………………………………………………………

Please Sign Complete Waiver On Reverse Hereof   →

 

 

BORDER OUTDOOR ADVENTURE ASSOCIATION - Continued

AGREED WAIVER OF CLAIM

The signatory/s herein acknowledge that Border Outdoor Adventure Association, hereafter called the BOAA, organises, facilitates, and encourages a wide range of activities including associated transport which are/could be dangerous and could  result in physical injury and/or death and/or damage to property.

The signatory/s herein hereto acknowledges that the participation in the activities of the BOAA is at the signatory/s sole and absolute risk, and is participated freely, voluntarily, and with consent and full knowledge of the potential risk/s and consequence/s.    

I/We*, the undersigned, hereby irrevocably waivers and abandons any claim/s of whatever nature that may arise for myself/ourselves*, my/our* heirs, executors and successors in title any and all rights  which I/We* may have or which may hereafter accrue to me/us* against the Border Outdoor Adventure Association,  and any of its representatives and officials. for any all injuries and or damages which may be sustained by myself/ourselves* directly, or for loss or damage to my/our* property arising in my/our* participation in any event, function or activity (Including transportation) of the BOAA. Furthermore I/we the undersigned indemnify/s ans absolve/s the BOAA against any claim/s which may arise from whatever nature, whether such claims arise from the fault of the BOAA including negligence or otherwise.  

I/We* as parent/s and guardian/s  of the minor/s mentioned below consent to such minor/s being bound by the foregoing and further indemnify the BOAA to the extent, if any, to which such minor/s is/are not capable of waiving his/her rights as aforementioned. 

Signed At ..................................This the………………………………… day of......................200…...

Full name of member/ guardian:.....................................................                                     SIGNATURE.........................

Full name of spouse/guardian:.........................................................                                      SIGNATURE......................... 

Full name of minor:.........................................................................                                        SIGNATURE.........................   

Full name of minor:..........................................................................                                       SIGNATURE.........................  

Optional Information.

Medical Aid:

Medical Aid No:

Contact Details In Case Of Emergency:

Name of Person:

Tel. No:

Name Of Doctor:

Tel No:

 

 

Full name of minor:……………………………………………………………….                                             

SIGNATURE...........................................................................................................    

Full name of mimor:...............................................................................................                                     

SIGNATURE...........................................................................................................     

 

For Office Use:  Receipt No:                                                             Date: