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DURBANVILLE HOCKEY CLUB
Sports way, Durbanville, Western Cape, 7550
www.durbanvillehockey.co.za
MASTERS HOCKEY MEMBERSHIP APPLICATION FORM
2015
2015 Subscription fees
Masters
Full Subs
R1 750
Debit order
- R350 x 5 months
Registration fee of R875 must be paid before 17 April 2015.
Full subs must be paid by 30 June 2015, unless a debit order plan is in
use. If not, a player will be suspended until subs are paid in full. If after 31
May 2015, a player gets injured or for any other reason cannot complete
the season, they are still liable for payment of the full subscription fees. I
Payment Plan Options:
1. Pay full subscription fees by 17 April 2015 via EFT.
2. Pay registration fee of R875 by 17 April 2015 and remainder of
subscription fee by 30 June 2015 via EFT.
3. Sign up for a Debit Order by 17 April 2015.
Bank Details: Durbanville Hockey Club
Bank: Standard Bank
Branch: Tyger Manor
Branch code: 050410
Account Number: 072 003 561
Cheque/current account
Reference: SU-Member-Name 2015
Proof of payment must be emailed to the Treasure.
Glen Houston: [email protected]
If you are unable to make payment deadlines and wish to arrange
an alternative payment plan, please contact Glen Houston via
email and he will advise accordingly.
DURBANVILLE HOCKEY CLUB
Sports way, Durbanville, Western Cape, 7550
www.durbanvillehockey.co.za
MASTERS HOCKEY MEMBERSHIP APPLICATION FORM
2015
Surname:
Age:
First Names:
ID Number:
Gender: Male / Female
Ethnicity/Race:
White
(Required for the Dept. of Sport)
Black
Coloured
Asian
Other
Physical Address:
Postal Address:
Email Address (required):
Form will be returned for
completion if not included.
Contact Numbers:
Cell:
Home/Work:
Current DHC Shirt Number:
Umpire Grading:
(recorded to avoid duplicates)
Have you played for
another club in the
previous season?
Yes /
No
If yes, request a clearance letter from the
club and attach with this application.
Provincial
Colours:
Highest league played
previously:
(please specify)
Masters – R1750
Please select category:
I hereby apply for membership of the Durbanville Hockey Club for the 2015 playing season.
In signing this application form:
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I agree to abide by the constitution of the club and the Code of Conduct for the use of relevant
Astro facilities, as well as the playing regulations of the Western Province Hockey Union.
I agree to pay my registration fee of R875 or sign up for a debit order no later than 17 April
2015 or will forfeit my playing rights as of 18 April 2015.
I agree to pay the full subscription fee by 30 June 2015 if I have not signed up for a debit order
or will forfeit my playing rights as of 1 July 2015.
I agree to pay the full subscription fee in the event of injury or any other reason that prevents
me from playing after 31 May 2015.
I acknowledge that I am aware of the fact that I may not move to or play for any other club
affiliated to WPHU, SAHU or FIH until such time as any outstanding debts with Durbanville
Hockey Club have been settled in full and I am in possession of a letter from the club stating
this fact.
I agree to the NO PAY, NO PLAY rule which will be enforced throughout the season.
SIGNATURE: _________________________ DATE: ___________________
For Committee Use Only:
Committee Member Name:
Payment Plan:
Signed:
Date:
Payment Received:
YES / NO
Amount:
Payment Method:
(Please attach proof of payment)