2018 Membership Application Form

 

Cyloam Cycling

 

Name:
Gender:
I.D No.:
Cell No.:
Email:
CSA No.:
Chip No.:
 
I.C.E Name:
         Cell No.:
         Medical Aid:
         Medical Aid No.:
         Allergies:

 

 

Cost: R1200-00 (annual fee which includes)

  • Club Top (subsidized)
  • Membership Fee

 

 

Banking Details:

Bank: Standard Bank

Account Holder: Cyloam Cycling

Type: Current

Account No.: 300 324 693

Branch Code: 011842

 

*Use your name as reference when making payment.

And email denverm@orion-ils.co.za proof of payment


Download 
2018 Membership Application Form