nomination for associate

WANGANUI RSA

   NOMINATION FOR ASSOCIATE MEMBERSHIP

 

 

NAME OF CANDIDATE:   Mr / Mrs / Miss / Ms___________________________________________________________

 

OCCUPATION:_____________________________________________________________________________________

 

POSTAL ADDRESS:________________________________________________________________________________

 

DATE OF BIRTH:________________________________   EMAIL ADDRESS:_________________________________

 

PHONE NO:_____________________________________   SIGNATURE:______________________________________

 

HAVE YOU EVER BEEN DECLINED  MEMBERSHIP AT ANOTHER CHARTERED CLUB?     YES  /  NO

 

I am over the age of sixteen (16) and I undertake to abide by the rules and regulations of the Wanganui RSA Inc.

Written permission is required from parent/caregiver for Junior member (16 & 17 years) to join.

 

PROPOSER’S NAME:____________________________   SECONDER’S NAME:_______________________________

 

PROPOSER’S SIGNATURE:_______________________   SECONDER’S SIGNATURE:_________________________

 

DATE OF APPLICATION:_________________________  

 

DATE APPROVED BY COMMITTEE:________________   COMPUTER NUMBER:______________________________

 

MEMBERSHIP FEE ENCLOSED:___________________   (16 & 17 years $12.50, 18 years & over $25.00)

 

A PASSPORT SIZE PHOTO WILL BE TAKEN AND ATTACHED TO THIS APPLICATION