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Life Membership APPLICATION

Please enter your details below:
Surname
First Name:
Preferred Name:
Birthdate:
House at Bishops
Matric Year
Final Form at Bishops:
Years at Bishops	-
Address 1:
Address 2:
City:
Region:
Country:
Postal Code:
Primary Contact Number:	Please include international dialing code.
Home Fax:
Mobile Number:	Please include international dialing code.
Email Address:
Alternate Emaill Address:
Qualifications:
Occupation:
Current Employer:
Position Held:
Partnet / Spouse Name:
Marital Status:
Children Details: (Name, Gender, Date of Birth)
Sports Played:
Interests:
Method of Payment:	Electronic Transfer Cheque Postal Order

ODU Banking Details:	Standard Bank: Rondebosch Branch code: 025009 Account number: 071473637 Please fax (+27 21 685 1829) or email (odu@bishops.org.za) proof of payment if using the EFT Option.