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Paihia Ex-Servicemen's Assn

Membership Application Form

FULL NAME:________________________________________

Male/Female__________________                                         

                                                                           (Please print clearly)

FULL POSTAL ADDRESS: __________________________________

______________________________________________________

OCCUPATION:____________________________    Phone: _____________

E Mail address: _________________________________

I hereby apply for membership of the Paihia Ex-Servicemen’s Assn (Inc).

I certify I am over 18 Years of Age. If accepted I agree to abide by the Rules under the Constitution of this Association.

APPLICANTS SIGNATURE:__________________________

NOMINATED BY (Print Clearly)________________________________

SECONDED BY (Print Clearly) ________________________________

DATE OF APPLICATION: _________________________________

Subscription and Nomination fees must accompany this application.

NOMINATOR and SECONDER must have been financial members of this Club for at least 12 months

NOMINATION $20.00   SUBSCRIPTION $40.00   TOTAL $60.00

Office Use

Date Received:______________  Amount: $________   Receipt No: __________

Comments:______________________________________________