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membership form

 

Click PDF or WORD icon below to download Membership Form

        

 

 

 

 

 

Manukau Model Power Boat Club

Application for Membership & Membership renewal form

 

Full Name:

Address:

Telephone Number:

Mobile Number:

Email Address:

Membership fees due for the period June 2014 to June 2015       

Enter your Fee here $__.__

Membership fees are as follows: option A: Full adult membership               $120.00

                                                Option B: $40.00 Club Subs and $10each race day

Email the Secretary for club bank account details if you wish to direct credit your fees

 

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Please sign the Privacy Statement below and return form to Club Treasurer with your fee payment.

I consent to the collection of information related to my name and address for the purpose of affiliation to Manukau Model Power Boat Club.

I further consent to this information being used as appropriate with the news media for publicity purposes.

I acknowledge my right to access and, if necessary, correct this information.

This consent is given in accordance with the privacy Act 1993.

Signed: __________________________________ Date: _________________

Receipt # _______________