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
Do you need a new card ?
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 )
SENIOR MEMBERSHIP
Please Note* A credit card fee has been added

$103.29 NZD Quantity



Handle Club
Please Note* A credit card fee has been added

$10.60 NZD Quantity



Vino Club
Please Note* A credit card fee has been added

$5.50 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:

EARLY BIRD SENIOR MEMBERSHIP RENEWAL FORM