FULL NAME:

 

AGE:

 

STREET ADDRESS:

 

POSTAL ADDRESS:

 

TELEPHONE :  HOME :                                              WORK:       

 

CELLULAR PHONE:

 

FAX:

 

E- MAIL :

 

MARITAL STATUS:

 

PREFERRED METHOD OF CONTACT:  PHONE/FAX/E-MAIL (circle one)

 

 

I HEREBY APPLY TO BECOME A MEMBER OF SOUTHERN CAPE JEWISH COUNCIL.

 

I AGREE TO BE BOUND BY IT’S CONSTITUTION.

 

I ENCLOSE MY MEMBERSHIP FEE OF R          .

 

 

 

 

………………………                                                  …………………..

SIGNATURE                                                                  DATE