Membership

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Headline 1

SURNAME: Mr/Mrs/Miss/Ms

FIRST NAME:

Are you, or have you ever been known by another name?

If YES, please write the other name in full:

Are you a New Zealand Citizen?

Are you a permanent resident of NZ in terms of NZ Immigration Policy?

Are you a citizen of a country belonging to the Commonwealth of Nations?

Have you ever been convicted of a crime?

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Name of Club:

Reasons:

Signature of Applicant:

Date:

APPLICANT TO COMPLETE
PROPOSER / SECONDER DETAILS – PLEASE PRINT YOUR NAME
PROPOSED BY:

MEMBERSHIP NO:

I have known the applicant for

SIGNED:

Please Note: Your personal details below are for Office Use only and are not for display.
For the privacy of the applicant, the section below will be folded back before photocopying the top section for posting on the notice board section for new members.

ADDRESS:

SUBURB:

CITY:

POSTCODE:

CONTACT PHONE NUMBER (HOME):

CONTACT PHONE NUMBER (WORK):

MOBILE NUMBER (WORK):

EMAIL: (required)

DATE OF BIRTH:

OCCUPATION:

(This is required for identification purposes)

Please Select Sections Interested In:
Option 1Option 2Option 3Option 4Option 5Option 6Option 7

Please note:
Nullam laoreet nunc nunc, et vulputate nisl aliquam quis. Cras quis ante in dolor consectetur commodo nec molestie lacus. In a est mi. Quisque lacinia tortor erat, ac vehicula leo ornare id. Nulla porttitor orci in pretium ullamcorper. Fusce ultrices interdum mi, vitae sodales erat accumsan non. Morbi dictum leo erat, et rutrum urna euismod fermentum.
Please note:
Nullam laoreet nunc nunc, et vulputate nisl aliquam quis. Cras quis ante in dolor consectetur commodo nec molestie lacus. In a est mi. Quisque lacinia tortor erat, ac vehicula leo ornare id. Nulla porttitor orci in pretium ullamcorper. Fusce ultrices interdum mi, vitae sodales erat accumsan non. Morbi dictum leo erat, et rutrum urna euismod fermentum.

Signature of Applicant:

Date:

Membership

Headline 1

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