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ONLINE MEMBERSHIP REGISTRATION FORM

The information you provide in the online registration form will be captured by the NCCU and you will be contacted with confirmation of your application.

MEMBER DETAILS
ID NUMBER
TITLE
FIRST NAMES
SURNAME
MARITAL STATUS
Married Single Divorced Other
NUMBER OF DEPENDANTS
RACE
Black Coloured Indian Asian White Other
Preferred Language
   
CONTACT DETAILS
Work Telephone
Code Number
Home Telephone
Code Number
Cellular Number
   
Residential Address
 
 
  Code
   
Postal Address
 
 
  Code
   
Email Address
Preferred Password For accessing members area of website.
   
EMPLOYER DETAILS
Company Name
Sector
Designation
Employee Code/Number
   
BANKING DETAILS
Name of Account Holder
Name of Bank
Account Number
Branch Code
Account Type
Cheque Transmission Savings
   
DEBIT AUTHORIZATION
 

By ticking this checkbox I hereby agree that my monthly subscription of R65-00 may be debited from my account and paid to the NCCU via debit order.

I also agree by entering into this agreement with the NCCU this membership will automatically cancel and replace subscriptions to any similar organization.

   
TERMINATION OF MEMBERSHIP
  By ticking this checkbox I hereby agree that I will give 30 days notice when I choose to terminate my membership with the NCCU, and will be indebted to the NCCU for the notice month.
   

 

 


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