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WP Vets Registration Form

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					       WESTERN PROVINCE VETERANS TENNIS ASSOCIATION

            P O Box/Posbus 21, Rondebosch, 7701 : Lovers Walk, Rondebosch, 7700
              Chairman: Barbara Rose-Innes 083 701 6045 - Fax/Faks: 021 685 5293
              e-mail: barb-r-i@mweb.co.za   Website: www.wptennis.co.za/veterans


                            REGISTRATION FORM 2011


TITLE:        MR ∏     MRS ∏     MISS ∏     MS ∏     DR ∏    PROF ∏            M / F


SURNAME:

FIRST NAME:

ID NUMBER:

CLUB:                                                       LEAGUE STATUS:

PROFESSION:

NEW SATA NO:



POSTAL ADDRESS:




                                                                      CODE:

HOME TEL:

WORK TEL:

FAX:

CELL:

EMAIL:

WP Subscription for 2011, R100-00

PAYMENT:

Post to:               WP Tennis, P.O. Box 21, RONDEBOSCH, 7700

Or

Direct Deposit:        Account: WP Tennis Veterans,
                       ABSA – Account No. 92 0305 3463
                       Claremont Branch No. 332 509
                       Please clearly print your name under reference.

				
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