New membership application
NAME ____________________________________________

POSTAL ADDRESS_________________________________

___________________________________

___________________________________


TELEPHONE NUMBER (HOME)_______________________

CELLPHONE NUMBER ________________________________

FAX ________________________________________________

E-Mail _______________________________________________


Artist/ or artlover_________________________________

Medium:_________________________________________

Membership fees: R150 per annum
Please contact Ilona : 082 893 6718or Annemarie : 083 564 1817
for more information
cpetzer@soft.co.za
Bank Details: Absa Nelspruit, Savings
Laeveld Kunsvereniging