SENIOR INTERMEDIATE MEMBERSHIP RENEWAL FORM

SENIOR INTERMEDIATE MEMBERSHIP RENEWAL FORM

Please fill out form correctly
SENIOR INTERMEDIATE MEMBERSHIP IS 17-21 YEARS OF AGE ONLY

If you are 21 years or older please exit this form and fill out the senior membership form.
Membership Renewal or New Membership
Name
Postal Address
Phone Number
Email
example@example.com
Date Of Birth

MonthDayYear
DOB
Male / Female
Membership Type
Do you need a new card
PLEASE ONLY FILL OUT NEXT SECTION IF YOU ARE PAYING WITH CREDIT CARD -
Because it is nearing the end of season you will be charged for the current season PLUS the 2027 season

This will take your membership through to 30th September 2027
Please Select & Enter Quantity
prevnext( X )
SENIOR INTERMEDIATE MEMBERSHIP
Please Note* A credit card fee has been added

$87.84 NZD Quantity

Total

$0.00 NZD
Additional Comments
DECLARATION

I declare that the above information is correct. I agree to abide by the Club Rules & Constitution through my entire duration of membership to the Whangarei Deep Sea Anglers Club Inc

ANNUAL MEMBERSHIPS ( 1st OCTOBER - 30th SEPTEMBER )
By selecting YES I declare that the information provided is correct & agree to the declaration above.
Should be Empty:

SENIOR INTERMEDIATE MEMBERSHIP IS 17-21 YEARS OF AGE ONLY