Born2Run Athletics Club Membership Form FULL NAME IDENTITY NUMBER AGE SEX OCCUPATION CELL NUMBER EMAIL ADDRESS PHYSICAL / POSTAL ADDRESS What size Born 2 Run Club vest do you require? ⃝ S Would you like to order a Born 2 Run Club peak? (R130 ea) ⃝ M ⃝ ⃝ L YES ⃝ XL ⃝ Grey ⃝ XXL NO ⃝ White ⃝ Would you like to order a PUMA Ladies Club t-shirt? (R300 ea) ⃝ S ⃝ M ⃝ L ⃝ XL ⃝ XXL Would you like to order a PUMA Men’s Club t-shirt? (R300 ea) ⃝ S ⃝ M ⃝ L ⃝ XL ⃝ XXL Would you like to order a PUMA beanie? (R110 ea) ⃝ YES ⃝ NO Would you like to be added to the club mailing list? ⃝ YES ⃝ NO Did you belong to a different running club in 2014? If so, please provide a clearance letter. ⃝ YES ⃝ NO Do you follow Born 2 Run AC on twitter? @born2runac ⃝ YES ⃝ NO Do you follow Born 2 Run AC on facebook? ⃝ YES ⃝ NO Are you registered with parkrun SA? ⃝ YES ⃝ NO Have you registered with ASA online? ⃝ YES ⃝ NO FEES ⃝ ⃝ Please deposit fees via EFT into the following account: ⃝ ⃝ ⃝ R500 R300 R300 R130 R110 Early Bird Joining Fee Ladies Club tee Mens Club tee Club Peak PUMA Beanie Born 2 Run Athletics Club First National Bank TOTAL PAYABLE Acc No. 62468178580 R_____________________ Branch. 220725 (Howick) Reference: Surname, Fees PLEASE ATTACH PROOF OF PAYMENT Membership to Born 2 Run Athletics Club entitles you to a 20% discount on all Puma active and casual wear sold at retail outlets throughout South Africa. Simply take proof of identification with you when you visit your local Puma Retail Store. Please return this form, a completed ASA licence form and POP to Ann at [email protected]. We look forward to running with you! Born 2 Run AC Membership Fees (2015) Early Bird Joining Fee (October 2014 to end November 2014): R500 Annual Membership Fee (December 2014 onwards): R700
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