HBNW Member Registration Form

Personal Information
Field marked with (*) are mandatory
Title *:
First name *:
Surname *:
 
Residential Address : ( please include street number and name, or appt number and complex name, where applicable )
Do you live in*:
  a house
  a flat or apartment
House Number *:
Street Name *:
Estate Name :
Hout Bay Area *:
Hout Bay Block *:
Home Phone *:
Cell Phone *:
Work Phone *:
ERF Number :
GPS Co-ords (Latitude) :
GPS Co-ords (Longitude) :
  The email address and password provided here will be used to create your website Account.
E-mail address *:
Password *:
Repeat password *:
 
Security company :
ADT
Deep Blue
Chubb/Deep Blue
None
OTHERs
Please specify in the field below
Patrolling Preferences
Are you available for patrolling?
 
Night Patrol
Daylight
No
Night Patrol - do you have any preferences?
We will try to accommodate you where possible.
 
Daylight Patrol - Please tick when you would be available
 
Weekly
Fortnightly
Monthly
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Preferred time of day
Partner Preferred :
  Yes       No
Name of Preferred Partner :
How would you like to get involved?
Are you prepared to assist with the following:
 
Recruiting members for Neighbourhood Watch
Making a financial contribution towords radio and other equipment purchase
  Please indicate amount  
Making a regular monthly donation towards the operating costs of Neighbourhood Watch
  Please indicate amount  
Providing assistance in an Administrative capacity
Providing assistance for Fund Raising of Social Events
Other skills that you have :
 
Security Code *:
 
 
 
 

 
   Site Last Updated:     24 Mar 2017    
    Thank you to all who donate and assist us
We do not charge for membership and there is no expectation that members have to contribute financially. However we need to maintain the systems that keep YOU safe. So we welcome donations from residents and businesses alike. 
For more details on Area Safety Plans and the spending of area specific donations (ring-fenced funds) please contact your Area Leader.
Please help us to help you and make a donation today!
Reference "Watchcon" & your name/cell number 
Our Banking Details:
Bank: Nedbank
Branch: Hout Bay
Branch code: 167 609
Account type: Cheque
Account No: 167 602 9133
Account name: Hout Bay Neighbourhood Watch
 
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