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2020 JSC Membership Form
Please complete and submit this membership form.
Membership fee : R900.
This will be added to your Jump Account.
When making payment use reference: Full name & 2022 Member.
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* Indicates required question
Title
*
Mr
Mrs
Ms
Other:
Required
Name & Surname
*
Your answer
Address
*
Your answer
Cell Number
*
Your answer
Email Address
*
Your answer
ID Number (Passport Number)
*
Your answer
Occupation
*
Your answer
Medical Aid Details, Plan & Number
*
Your answer
Next Of Kin & Contact Number
*
Your answer
Reserve Repack Date
*
MM
/
DD
/
YYYY
Weight
*
Your answer
Canopy Size
*
Your answer
PASA Number
*
Your answer
Time in Sport
*
Your answer
Number of Jumps
*
Your answer
Existing Licence
*
Your answer
Current Ratings
*
JM
Coach
PRO
SL Instructor
AFF Instructor
Tandem Instructor
Other
None
Required
Medical : Do you suffer or are you being treated for any of the following - please tick relevant blocks
*
Epilepsy
Diabetes
Heart Condition
Blackouts / Dizzy spells
High Blood Pressure
Low Blood Pressure
Asthma
Ear Problems
Dizzyness
Infections
Eyes
Corrective Lenses
Single Eye / Limited Vision
Previous fractures (legs)
Previous fractures (ankles)
Previous fractures (back)
Previous fractures (wrists)
Previous fractures (shoulders)
Other
None
Required
Medical : Briefly describe above injuries if any
Your answer
Substances: Are you currently on any medication and what medication?
Your answer
Substances : Are you currently addicted to alcohol and/or drugs?
*
Yes
No
If yes to above, briefly describe
Your answer
Blood Type & Allergies
*
Your answer
By ticking yes below you agree to the T&C's on the JSC website and thereby confirming your JSC membership at R900 yearly fee
*
Yes, I agree
Required
CABIN OWNERS - 2022
Are you a cabin owner?
*
Yes
No
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