Request Membership
2019 SEASON MEMBERSHIP
• Single $40.00
• Double $60.00
• Permanent $500.00
Membership Number _____________________
NAME: ______________________________________________________________
ADDRESS: ___________________________________________________________
TOWN & POST CODE
HOME PHONE: _______________________________________________________
MOBILE PHONE: ______________________________________________________
EMAIL ADDRESS: ____________________________________________________
Payment of Membership Fees:
Internet Banking into ASB A/C 12 3031 0888464 00.
If using Internet Banking please reference your FULL NAME and email this form to me OR
Post your cheque and form to PO Box 1004 Pukekohe 2340
Please pay your membership early pre season to avoid delays at the door.
AMOUNT PAID: _______________________
By taking out this membership I / we agree to abide by the Rules of the Club as set by the Committee and or Constitution. Sign below in the space provided.
X____________________________________ ____________________________________
Guests are Authorised customers of the club who must sign onto the Registry while at all times be accompanied by a member of the club. Any person, who is not a Financial Supporters Club Member, can only sign on to the Registry (unless they meet the conditions of clause 3.6 of the Constitution) once per season. Future admission to the Supporters Club from that time is by way of a Financial Membership in compliance with current legislation
Please Sign and Return this Form to Doreen with payment
doreenthomson5@gmail.com