Registrations 2024 2024 Registration - Hollywood Athletics Club Identification Type Birth Certificate Passport ID Document ID Number/Passport ASA License Number 2023 ASA License Number 2024 ASA Province KZNA (KwaZulu-Natal Athletics) CGA (Central Gauteng Athletics) AGN (Athletics Gauteng North) AFS (Athletics Free State) EPA (Eastern Province Athletics) ANWN (Athletics North West North) Disciplines interested in Road Running Race Walking Cross Country Track & Field Title Mr Mrs Miss Ms Dr Other First Name Surname Email Address Gender Male Female Date of birth Residential Address Street Number Street Name House/Apartment Number House/Apartment Name Suburb City Province KwaZulu-Natal Gauteng Western Cape Eastern Cape Free State Limpopo Mpumalanga Northern Cape North West Postal Code Telephone Number (Cell) Telephone Number (WhatsApp) Emergency Contact Full Name Emergency Contact Number Medical Aid Yes No Medical Aid Name Medical Aid Number Please indicate below how you are willing to assist with club during the year Club Gazebo Volunteering Hollywoodbets Durban 10km Volunteering Hollywoodbets Joburg 10km Volunteering Seconding Select your membership Senior Member (Vest/T-Shirt and 2024 License Included) – R450 Existing Member Re-Registration (2024 License Included) – R200 Junior Member (19 or Younger for the Duration of 2024) (Vest/T-Shirt and 2024 License Included) – R350 Pensioner Member (65 or older) (Vest/T-Shirt and 2024 License Included) – R350 Hollywoodbets Team Member (Vest/T-Shirt and 2024 License Included) – R350 Laser Cut Vest X-Small Small Medium Large X-Large XX-Large Please select your preferred Hollywoodbets Branch to collect your licence and/or kit once notified Eastern Cape Bizana Eastern Cape Govan Mbeki Eastern Cape Grahamstown Eastern Cape Jeffreys Bay Eastern Cape Korsten Eastern Cape Mandarin Inn Eastern Cape Mthatha Eastern Cape Newton Park Eastern Cape Ngcobo Eastern Cape Parliament Street Eastern Cape Queenstown Eastern Cape Quigney Eastern Cape Regional Office Free State Phuthaditjhaba Gauteng Alberton Gauteng Boksburg Gauteng Brakpan Gauteng Daxina Gauteng Germiston Gauteng Kempton Park Gauteng Lenz Station Gauteng Newtown Mall Gauteng Premium Bet Gauteng Pretoria Gauteng Regional Office Gauteng Soweto KwaZulu-Natal Bayview KwaZulu-Natal Bluff KwaZulu-Natal Chatsworth KwaZulu-Natal Dukwahs KwaZulu-Natal Malvern KwaZulu-Natal Phoenix KwaZulu-Natal Pinetown KwaZulu-Natal Raisethorpe KwaZulu-Natal Richards Bay KwaZulu-Natal Stonebridge KwaZulu-Natal Verulam KwaZulu-Natal Yusuf Dadoo Kwa Zulu-Natal Argyle Kwa Zulu-Natal Brackenham Kwa Zulu-Natal Empangeni Kwa Zulu-Natal Estcourt Kwa Zulu-Natal Greyville Kwa Zulu-Natal Isipingo Kwa Zulu-Natal Ixopo Kwa Zulu-Natal KwaDukuza Kwa Zulu-Natal Ladysmith Kwa Zulu-Natal Umhlanga Kwa Zulu-Natal Newcastle Kwa Zulu-Natal Osizweni Kwa Zulu-Natal Park Kwa Zulu-Natal Pietermaritz Street Kwa Zulu-Natal Pietermaritzburg Kwa Zulu-Natal Scottsville Kwa Zulu-Natal Shelly Beach Kwa Zulu-Natal Stanger Limpopo Bela Bela Limpopo Burgersfort Limpopo Giyani Limpopo Makhado Limpopo Malamulele Limpopo Mokopane Limpopo Musina Limpopo Phalaborwa Limpopo Polokwane Limpopo Regional Office Limpopo Thohoyandou Limpopo Tzaneen Mpumalanga Emalahleni Mpumalanga Ermelo Mpumalanga Hendrina Mpumalanga Kinross Mpumalanga Mashishing Mpumalanga Middelburg Mpumalanga Mkhondo Mpumalanga Mbombela Mpumalanga Regional Office Mpumalanga Secunda Southern Cape Boulevard Southern Cape George Southern Cape Knysna Southern Cape Mossel Bay Southern Cape Regional Office Southern Cape Voortrekker Western Cape Beacon Valley Western Cape Bellville Western Cape Du Noon Western Cape Durbanville Western Cape Kenilworth Western Cape Kuilsriver Western Cape Lansdowne Western Cape Maitland Western Cape Malmesbury Western Cape Montague Gardens Western Cape Paarl Western Cape Parow Western Cape Philippi Western Cape Regional Office Western Cape Somerset West Western Cape Stellenbosch Western Cape Vasco Western Cape Waterkant Western Cape Woodstock Western Cape Worcester Western Cape Wynberg Western Cape Durbanville Racecourse Western Cape Kenilworth Racecourse If you are a Hollywoodbets Team member, please enter your employee code Club Clearance If I have been a member of a different Athletics Club, I understand that I am required to send a Clearance Letter from my previous club to [email protected] within 30 days of joining Hollywood Athletics Club Payment EFT Banking Details: Hollywoodbets Athletics Club Bank: Nedbank Account Number: 1185626069 Branch Code: 198765 Account Type: Cheque Reference: AC (Name & Surname) as per ID document Declaration I declare that I am a bona fide athlete/coach/technical official/administrator. I confirm that all the information provided on this application is true and correct. I subject myself to the rules and regulations of Athletics South Africa and the IAAF, and I undertake not to compete in any athletics event which is not sanctioned by the provincial athletics body and ASA. I indemnify ASA, the provincial body, sponsors and organisers of any event against all and any action of whatever nature which may arise out of my participation, and I agree that it is my responsibility to be medically fit to compete in any event. I agree that ASA and any event organiser may utilise any image taken of me during an event in which I participate to record and or promote that event or any similar event. This does not include permitting the image to be utilised for commercial purposes or in association with any brand or trade name, other than that of the event itself, without my express consent. I agree I understand that 2024 Licenses will only be available once they have been allocated to Hollywood Athletics Club. This is expected in February 2024. New Members will receive their T-Shirt/Vest upon allocation of the license. Register
