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About
Club Constitution
Commissions
Membership
Club Kit
Registration
Training
General Info
Contact us
REGISTER
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REGISTRATION YEAR
*
2024
THIS YEAR MUST BE SELECTED
MEMBERSHIP 2024
*
RENEWAL OF MEMBERSHIP
NEW MEMBER
SOCIAL MEMBER
NEW SOCIAL MEMBER
70 YEARS AND OLDER MEMBERS R2OO IF AFFILIATED TO ANOTHER CLUB
YEAR FIRST JOINED
TITLE
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Mr
Ms
Mrs
Dr
NAME
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INITIALS
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SURNAME
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STATUS
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SENIOR 20 years +
JUNIOR 19 years and under
HIGH SCHOOL
PRIMARY SCHOOL
I AM A
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ATHLETE
COACH
TECHNICAL OFFICER
OFFICE BEARER
DISCIPLINE
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ROAD RUNNING
OFF ROAD RUNNING
RACE WALKING
TRACK AND FIELD
DEMOGRAPHICS - SRSA Requirement
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BLACK
COLOURED
INDIAN
WHITE
OTHER
GENDER
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MALE
FEMALE
DATE OF BIRTH YYYY / MM / DD
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TYPE OF DOCUMENT
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S A ID
PASSPORT
BIRTH CERTIFICATE
REFUGEE PERMIT
SOUTH AFRICAN IDENTIFICATION NUMBER
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SA ID NUMBER MUST BE 13 DIGITS
PASSPORT NUMBER / BIRTH CERTIFICATE NUMBER / PERMIT NUMBER
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LICENCE NUMBER 2023
LICENCE NUMBER 2023
HOME PHONE
Email
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MOBILE PHONE
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STREET NUMBER AND NAME
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SUBURB
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CITY
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POST CODE
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OCCUPATION - SRSA Requirement
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NEXT OF KIN OR EMERGENCY CONTACT NAME
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First
Last
EMERGENCY CONTACT BE SOME WHO IS UNLIKELY TO RUN IN THE SAME RACE AS YOU OR ATTENDING THE SAME FUNCTION AS YOU
NEXT OF KIN MOBILE NUMBER
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NEXT OF KIN RELATION
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SIGNATURE
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DECLARATION: BY SIGNING THIS DOCUMENT I AGREE TO ASSIST WITH MARSHALLING THE CLUBS RACES VIZ THE SLAVE ROUTE CHALLENGE. I ALSO AGREE TO WEAR THE DESIGNATED CLUB RUNNING SHIRT IN ALL OFFICIAL RACES DECLARATION: 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 athletics related events are 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, approves of the declaration above, and signs it on my behalf. 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 athletics related events are 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, approves of the declaration above, and signs it on my behalf.
Date
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SIGNATURE OF PARENT OR GUARDIAN [YOUNGER THAN 18 YEARS]
DECLARATION: BY SIGNING THIS DOCUMENT I AGREE TO ASSIST WITH MARSHALLING THE CLUBS RACES VIZ THE SLAVE ROUTE CHALLENGE. I ALSO AGREE TO WEAR THE DESIGNATED CLUB RUNNING SHIRT IN ALL OFFICIAL RACES DECLARATION: 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 athletics related events are 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, approves of the declaration above, and signs it on my behalf. 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 athletics related events are 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, approves of the declaration above, and signs it on my behalf.
Date
ANNUAL FEES
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SENIOR/ORDINARY [R250 + R180(FOR LICENCE)] = R430
JUNIORS & STUDENTS -19YRS AND UNDER [R150 + R60 (FOR LICENCE)] = R210
STUDENTS OLDER THAN 19yrs- (R150 + R180 (for licence) = R330 Student Card must be produced.
60 to 69 Years [R150 + R180 (FOR LICENCE) = R330
70 YEARS AND OLDER - FREE (Club will pay for the Licence)
SOCIAL R200 - Note- Social members are not covered by WPA Licence insurances -
70 YEARS AND OLDER -R200- IF AFFILIATED TO ANOTHER CLUB
Banking Details Itheko Sport Athletic Club Standard Bank Account 272118613 Branch Code 026209 REF: YOUR NAME + MF [membership fees]
PAYMENT METHOD - PAYMENT CANNOT BE MADE FROM THIS PAGE
*
EFT ONLY - THIS PAYMENT CANNOT BE MADE FROM THIS PAGE
CREDIT AND DEBIT CARD PAYMENT CAN BE MADE AT THE CLUB
Banking Details Itheko Sport Athletic Club Standard Bank Account 272118613 Branch Code 026209 REF: YOUR NAME AND ID NUMBER
MY PREVIOUS RUNNING EXPERIENCE
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NEW TO RUNNING
OCCASSIONAL JOGGER
10KM RACE
15KM
21.KKM
30/35KM
MARATHON
ULTRA MARATHON
I AM WILLING TO ASSIST THE CLUB IN THE FOLLOWING
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ADMIN
COACHING
SOCIAL COMMISSION
ONLINE, WEBSITE and NEWSLETTER
NONE
NOTE: SOCIAL COMMISSION ASSISTING AT OUR GAZEBO AT SELECTED RACES
PROMOTIONAL MATERIAL
*
I WANT TO RECEIVE PROMOTIONAL MATERIAL
I DO NOT WANT TO RECEIVE ANY
CONSENT
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I GIVE CONSENT FOR MY INFORMATION TO BE SHARED WITH THE CLUB SPONSOR
NO I PREFER NOT TO
MEDICAL AID NAME
MEDICAL AID
FULL PLAN
HOSPITAL PLAN ONLY
NONE
MEDICAL AID NUMBER
PRINCIPAL MEMBER
CHRONIC MEDICAL CONDITIONS
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HYPER TENSION
DIABETES
HEART CONDITION
NONE
OTHER
IF OTHER PLEASE STATE HERE
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CHRONIC MEDICATION
Submit
Road Running
Track & Field
Trail Running
Walking
You don't stop running because you get old, you get old because you stop running
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