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APPLICATION FOR MEMBERSHIP 2011-2012
Full Name:
Address: .
Box No.: (If applicable) Phone: .. (Home) . (Work)
Email address . Cell ....................D.O.B
Family Membership Please complete the following details of those family members who you wish to become members also. Family Membership constitutes Senior Man, Spouse and at least one Junior member (under the age of 13 years as at 1 June).
Lady Member (Name): D.O.B .
Junior Members (Details): . D.O.B: . Age:
. D.O.B: . Age:
. D.O.B: . Age:
. D.O.B: . Age:
I/We hereby apply for membership as a * member(s) and if elected, I/we agree to abide by the Constitution and Rules of the Club . * enter one of the following categories
Applicants Signature:
Date:
Senior Man: $120 * Lady:$120 * Country: $80 * Country Lady: $80 * Associate: $25.00 * Family: $270 * Day Member: $30 * Student: $45 A Student Member is a person over 13 year and up to 18 years at the 1st June 2011 * Junior: $30 A Junior Member is a person under 13 years at 1ST June 2011:
PAYMENT MUST ACCOMPANY APPLICATION
Proposer (Please print): .. Signature:
Seconder (Please print): .. Signature:
(Proposer or Seconder must be a Hawkes Bay Sports Fishing Club Committee Member) Particulars of Craft for Registration
Name of Boat:
Make: Model:
Motor Make HP .
Length: Trailer Rego:
Colour: Hull: Deck:
Radio: VHF Yes No ..
Cell phone No.: .
For Club Use
Subscription Paid: $ (Amount) Receipt No.:
Entered on Computer: .. (Initials)
Membership No. Allocated: . .
Entered on Boat Register: .
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