REGISTER

Dear Resident/ Community Member,

The CPF is a voluntary body of local residents, elected by the community, who have accepted the responsibility of supporting the police in ensuring our homes and loved-ones are safe and to be able to enjoy the quality of life we deserve. These activities require the support of dedicated, caring individuals and businesses that recognise the value of a peaceful, prosperous existence without crime.

Kindly complete the form below to enable us to register you on our database for communication purposes and to keep you up to date on developments.

Section 1: Database Registration

* required fields
*Name:**	*Surname:**
*Residential Address:**
Telephone number/s	Land line: Cellular:
*E-mail address/s:**
Occupation:
Employer/ Company:
Status:	Owner: Tenant: Business: Group / Institution:
Children:	Primary School: High School:

If you are able to assist the community in any small way, kindly indicate with a tick in the space provided and we shall contact you to run through the options available personally with you.

Financial
Donation:

Business
Sponsorship:

Community
Services:

Other: (Please elaborate)

Section 2: CPF Link Membership

Please consider my application as a bona-fide member of the Fairland community for the following Annual Membership.

Corporate Member R6000

Community/Organisation R600

Home Owner/Resident R240


Please select payment method (1 or 2):

1: Electronic Bank Transfer Confirmation: I prefer an electronic transfer
	Account Name: Fairland Community Police Forum
	Bank: First National Bank	Amount: R
	Account Number: 51440081522	Date of Transfer:
	Account Type: Current Account	Reference Number:
	Branch: Cresta
	Branch Code: 254905

2. Debit Order Authorisation: I prefer a debit order form click here to access form