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NMMU SPORT CLUB REGISTRATION FORM
2016-17

NMMU Student / Staff Number: ID / passport Number:

Student / International Student / Staff / Community

Title Initials First Name Surname

Tel. No. (H) Tel. No. (W) Cell No.

E-Mail Address Gender M F Date of Birth

Address in Port Elizabeth (Current residential) Address (If you are not from Port Elizabeth)

INFORMATON REQUIRED FOR PLANNING PURPOSES: Population Group:

White / Coloured / Black / Chinese / Asian
School Attended:
/ Campus attending Classes: / Course studying:

All students, staff and community members are eligible to join according to the specific sport club regulations and constitution.

PLEASE INDICATE THE CLUB(S) YOU WISH TO JOIN BY PLACING AN “X” IN THE APPROPRIATE AREA

·  Students do not pay Membership Fees for these sport clubs

·  PLEASE TAKE NOTE: SOME CODE e.g Football , Hockey Students will pay a membership release / exit fee when requesting CLEARANCE CERTIFICATES. R150 for non-bursary holders and R300 for (ex-) & current bursary holders. This is an administrative fee in lieu of free club subscription, free regional and / or national Registrations, Free Biokinetist Service and Access to Fitness & Aquatics Centre, Transport and general club operational cost. Exit Fees are payable at NMMU Cashiers in respective Cost Centres. Please enquire from respective codes sport managers about clearances from N M MU sport clubs.

·  I indemnify the NMMU against any claim against the NMMU arising out of any injuries, loss or illness suffered or contracted by the applicant, myself or any third party representing myself or the applicant during the course of or arising out of his\her participation in sporting activities at the NMMU irrespective of the cause of such damages, illness or loss.

STUDENT X / COMMUNITY X / STUDENT X / COMMUNITY X
A301 0720 / Athletics (Scholars) / R270 / A316 0720 / Rowing / R1000
A301 0720 / Athletics (Juniors/Seniors) / R380 / A317 0720 / Rugby / R700
A303
0720 / Basketball / R250 / A320 0720 / Soccer / R250
A304 0720 / Chess / R200 / A323 0720 / Squash / R300
A305 0720 / Cricket / R750 / A324 0720 / Surfing / R400
A302 0720 / Cycling / R200 / A330 0720 / Aquatics: Swimming / R600
A308 0720 / Golf / ------ / A325 0720 / Aquatics: Water Polo / R600
A314 0720 / Hockey / R2000 / A326 0720 / Table Tennis / R200
A311 0720 / Judo / R250 / A328 0720 / Tennis / R300
A313 0720 / Karate / R250 / A329 0720 / Underwater sports / R500
A315 0720 / Netball / R250 / A329 0720 / Volleyball / R250
TOTAL: / TOTAL:

Signature______Date______Receipt Nr. ______