P O Box 476, Wanaka 9343
membership form 2009 - 2010
Please complete and return to the above address
Last Name(s): First name(s) of all family members:
(Please append date of birth [for membership category])
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Mailing Address: ............................................................................................................
Wanaka Address: ..........................................................................................................
(If different to above)
Telephone (Wanaka): ........................... (Other) ..............................
Email Address: .........................................................
Are you a member of another club? (If so, please name): ...................................................
If you do not wish your contact details to be published at the club, please tick .....
| Subscription Type |
Member Type |
Rate |
Plus Affiliation fee |
| Pee Wee (under 8) | Junior | Free | |
Junior - 1 Child, plus shared affiliation fee $5 per person 17 years and under |
Junior |
$40.00 |
$5.00 |
|
Junior - 2 Children, plus shared affiliation fee $5 per person 17 years and under * |
Junior |
$65.00 |
$10.00 |
|
Junior - 3 Children (or more), plus shared affiliation fee $5 per person 17 years and under * |
Junior |
$85.00 |
$15.00 |
| Family, ** | Any | $270.00 | plus shared affiliation fee: $15 per adult (18 years and over: $5 per person 17 yrs. and under) |
|
Family (Holiday) *** |
Any |
$135.00 |
plus shared affiliation fee: $15 per family |
Senior, plus shared affiliation fee $15 per adult (18 yrs. and over) |
Senior, Vet, Super Vet |
$130.00 |
$15.00 |
|
Associate |
Non-playing |
$50.00 |
TOTAL FEE ENCLOSED: ................................................................. DATE: .........................................
Direct Credit Account No. 03 1739 0005576 01
Office use only: Cheque: From .................................................................. No.: ...................... Bank: .........................................
Receipt No.: .................... Date Processed: ..................................... Date Banked: ..................................................