Request Membership

2018  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

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