ONLINE MEMBER REGISTRATION MEMBERS DETAILS First Name Surname Date of Birth Tel No. (H) Tel No. (w) Cell No. (H) Occupation Email Address Age Group Other u/5 u/6 u/7 u/8 u/9 u/10 u/11 u/12 u/13 u/14 u/15 u/17 u/19 u/23 Ladies Veterans Senior 1st Team 3rd Team 4th Team 5th Team Reserve Home Address Sport code registered for: Hockey Football Cricket Rugby Baseball Karate Running Social Member MEDICAL DETAILS (Allergies or any other serious medical conditions) Allergies Other Employer Employer Address Medical Aid Name Medical Aid No EMERGENCY DETAILS Contact Name Tel No. PARENTS / GUARDIANS DETAILS (For members under 18)   FATHER'S DETAILS MOTHER'S DETAILS ID Number Name Company Occupation Home Address Tel No. (H) Tel No. (W) Cell No. Email Address Please indicate your membership status: Current Membership New Membership Please indicate payment method: Cash Cheque Internet Transfer Post Dated Cheque Acceptance I acknowledge that i am liable for the full payments due before the season commences. I hereby apply for membership of Panorama Sports Club; I agree to abide by the Constitution, Code of Conduct of the Club and the Bye-laws of the affiliations i might be affiliated to. I would like to receive email communication from the Club.