PRICELESS HONOUR 116 NPC MEMBERSHIP FORM

THIS FORM NEEDS TO BE COMPLETED WITH A COPY OF YOUR COMPANY REGISTRATION AND PROOF OF ADDRESS.

COMPANY NAME:

REG NO:

COMPANY REPRESENTATIVE NAME:

BIRTH DATE:

OCCUPATION:

CONTACT NUMBER:

ALTERNATIVE NUMBER:

EMAIL ADDRESS:

PHYSICAL ADDRESS:

ARE YOU AN ACTIVE LISTENER OF BOK RADIO?YESNO

ARE YOU IN THE BROADCAST COVERAGE AREA OF BOK RADIO?YESNO

POLITICAL OFFICE BEARER / ACTING POLITICIANYESNO

FAMILY MEMBER OF BOARD OF DIRECTORSYESNO

PREVIOUS BOARD MEMBER OR STATION MANAGERYESNO

IF YOU WERE A PREVIOUS BOARD MEMBER OR STATION MANAGER, STATE REASON FOR LEAVING:

By submitting this application form, you accept that Priceless Honour 116 NPC will process your application through a screening process and the Station’s decision will be final. Should your application be successful, you will be required to attend the Station’s Annual General Meeting, and any other meetings where your input will be required. By signing below, you also confirm that all information declared above is true and accurate. 18+ age restriction to be considered a member of Priceless Honour 116 NPC.

DATE:

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