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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 *:
 
 
 
 
 
 
 
 
 
 
 
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Please use your HBNW userID (which is your email address) and password to login below.
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Benefits of membership How can I help?
 
Membership is for Hout Bay residents only
   Site Last Updated:   18 Jun 2013