Cresta Pride Connect Club forms

CRESTA PRIDE CONNECT CLUB SERVICES form: 2024/2025

Please check and edit the relevant information, then select Submit. Use the TAB button and mouse to navigate. AVOID THE ENTER BUTTON while filling in the form. Red asterisks (*) indicate required fields

Entry date:
Thursday 25th April, 2024
Title:
Initials:
First names (personal name): *
Surname (family name): *
Postal address, line 1: *
Postal address, line 2:
Postal address, suburb:
Postal address, city: *
Postal address, province:
Postal address, code:
Postal address, country:
Company name:
Physical address, line 1:
Physical address, line 2:
Physical address, suburb:
Physical address, city:
Physical address, country:
Mobile phone: * please enter at least one contact phone (mobile or work or home) or email in the labelled fields
Work phone:
Home phone:
Fax:
Email: @
ID number:
ID type and country:
Occupation:
Birthday:
Wedding anniversary:
Mode of payment:
Direct banking: Deposit CRESTA LODGE GABORONE, Stanbic Bank, Fairgrounds Branch, A/C # 9060000434855, Branch code 064967. Please email the deposit slip to: office@creativehouse.co.bw or fax to 390 0635, ensuring your name is on the slip
Payment arrangements:
Date for effecting payment arrangements:
Payment arrangements/ Collection advice/ Other notes to Cresta Pride Connect Club:
Existing Cresta card number is:

Entry date:	Thursday 25th April, 2024
Title:
Initials:
First names (personal name):	*
Surname (family name):	*
Postal address, line 1:	*
Postal address, line 2:
Postal address, suburb:
Postal address, city:	*
Postal address, province:
Postal address, code:
Postal address, country:
Company name:
Physical address, line 1:
Physical address, line 2:
Physical address, suburb:
Physical address, city:
Physical address, country:
Mobile phone:	* please enter at least one contact phone (mobile or work or home) or email in the labelled fields
Work phone:
Home phone:
Fax:
Email:	@
ID number:
ID type and country:
Occupation:
Birthday:
Wedding anniversary:
Mode of payment:	Direct banking: Deposit CRESTA LODGE GABORONE, Stanbic Bank, Fairgrounds Branch, A/C # 9060000434855, Branch code 064967. Please email the deposit slip to: office@creativehouse.co.bw or fax to 390 0635, ensuring your name is on the slip
Payment arrangements:
Date for effecting payment arrangements:
Payment arrangements/ Collection advice/ Other notes to Cresta Pride Connect Club:
Existing Cresta card number is:

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Programme updated 9th September, 2023, 12:17. Made in Botswana by David Alexander Young 2005-2023