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CMSA Registration Form for “Lift yourself by yourself” 23 Jan 2011
 

General Information

Name:

Surname:

Age:

Date of Birth:

Receipt Number:

Gender:

Physical Address:

Province:

Home Telephone:

Cell:

Email Address:

Company/School/University:

Physical Address:

Province:

Work Telephone:

Cell:

Emergency Information

Emergency Contact 01:

Physical Address:

Telephone Home:

Work:

Cell:


Emergency Contact 02:

Physical Address:

Telephone Home:

Work:

Cell:


Please note:

  • All Applicants should be at the Ashram at 8.00am.
  • Camp fee is R50.



 

 

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