OLD- KTTTOF Society Membership Application Form

Ko Te Tuara Totara O Fordlands Incorporated Society

MEMBERSHIP APPLICATION FORM
Today's Date

DayMonthYear
Date
YOUR DETAILS
Name

First NameLast Name
Date of Birth

DayMonthYear
Date
MaleFemaleOther
Occupation
Address

Address

Street Address Line 2

City/TownState / Province

Postal / Zip Code
YOUR CONTACT DETAILS
Mobile
Format: (000) 000-0000.
Home phone
Format: (000) 000-0000.
Email address
example@example.com
Terms and Conditions:

I understand and agree that,
1. By completing this form, you are not automatically a member.
2. Your application will be assessed by the Committee before membership approval. You may be asked to
3. You will be informed of the outcome by email or phone by the Committee Secretary or KTTToF staff.
4. You are allowing staff of the KTTToF Society to store your information for administrative purposes.
5. Your information will be stored in confidence.
Signature (By the one filling out this form)
Should be Empty:

Ko Te Tuara Totara O Fordlands Incorporated Society