EARLY BIRD SENIOR MEMBERSHIP RENEWAL FORM

EARLY BIRD SENIOR MEMBERSHIP RENEWAL FORM

Please fill out form correctly
Membership Renewal or New Membership
Name*
Postal Address*
Phone Number*
Email*
example@example.com
Date Of Birth *

MonthDayYear
DOB
Male / Female *
Membership Type *
Would you also like to renew or join Handle Club??

Handle Club $10 Per Year - Vino Club $5 Per Year
Please Select & Enter Quantity
prevnext( X )
EARLY BIRD SENIOR MEMBERSHIP Please Note* A credit card fee has been added
$92.99NZD Quantity



Handle ClubPlease Note* A credit card fee has been added
$10.60NZD Quantity



Vino ClubPlease Note* A credit card fee has been added
$5.50NZD 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:

Would you also like to renew or join Handle Club??