Email: | Phone: 086 1115 178 | Fax: 086 0103 684

Email: | Phone: 086 1115 178 | Fax: 086 0103 684

Register Online – Eastern Province Anglers Union

Register Online – Eastern Province Anglers Union2022-11-28T08:01:11+00:00

Eastern Province Anglers Union

    Patient Particulars

    Contact Details

    Medical Aid/Hospital Plan

    Emergency Contact 1

    Emergency Contact 2

    Medical Details

    Medical Condition(s)



    Banking Details

    Angling club members only

    The MONTHLY SUBSCRIPTION is payable BY MONTHLY DEBIT ORDER. Please complete the authorisation below. If you do not operate a bank account please call us at 0861 115 178 to make alternate arrangements and enable us to activate your Cell phone application I hereby authorise ELIXIR to draw against my/our account with the under mentioned bank (or any other bank or branch to which I/we may transfer my/our account) the sum of:

    R 25.00 (Twenty five Rand) PER MONTH

    1St Day of Next month and continuing until termination by me/us by giving you thirty days’ notice in writing. In the event of an increase in this amount in excess of 10% per annum, I must be advised by ELIXIR, prior to such withdrawal. All such withdrawals from my/our bank account by you shall be treated as though they had been signed by me/us personally. If this debit order is dishonoured for any reason, ELIXIR is authorised to resubmit it for payment until such time as it is honoured.

    The reference on your bank account will be “ELIXIR CELL APP”

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