FAMILY MEMBERSHIP RENEWAL FORM

FAMILY MEMBERSHIP RENEWAL FORM

Please fill out form correctly
If you have any additional family members to add, you will need to fill out a seperate form.

Please note we will use the same contact information for all family members, if you have additional emails to add to the newsletter please write in the comment section
Membership Renewal or New Membership
Name*
Postal Address*
Phone Number*
Email*
example@example.com
Date Of Birth *

MonthDayYear
DOB
Male / Female *
Membership Type *
Name
Date Of Birth

MonthDayYear
DOB
Male / Female
Membership Renewal or New Membership
Membership Type
Name
Date Of Birth

MonthDayYear
DOB
Male / Female
Membership Renewal or New Membership
Membership Type
Name
Date Of Birth

MonthDayYear
DOB
Male / Female
Membership Renewal or New Membership
Membership Type
PLEASE ONLY FILL OUT NEXT SECTION IF YOU ARE PAYING WITH CREDIT CARD -

CONTINUE TO DECLARATION IF YOU'RE ARE GOING TO PAY AT CLUB
Please Select & Enter Quantity
prevnext( X )
FAMILY MEMBERSHIP 2X JUNIORS 2X SENIORS Please Note* A credit card fee has been added
$206.00NZD Quantity

Total

$0.00NZD
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.*

YES
Should be Empty:

PLEASE ONLY FILL OUT NEXT SECTION IF YOU ARE PAYING WITH CREDIT CARD -