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TAUPO RSA (Inc)

Please print out this form

Application for Membership

P.O. Box 290, Taupo

Ph / Fax: 07-378 7476

Applicant:

Surname: _________________________   First Names:____________________________________

D.O.B.     ........... /.........../............               E/Mail:________________________________________

Address:_______________________________________________________________

______________________________________________________________________

Phone Number:  (Home) ______________________      (Work) _________________________

Are you a member of any other club in Taupo?________________________________________

Why do you want to become a member?_______________________________________________

______________________________________________________________________________

Proposer:___________________________ Member No:________  Signed_____________________

Seconder:__________________________  Member No:________  Signed:_____________________

Signature of Applicant:____________________________________

Acceptance of $10 nomination fee does not confirm membership of the Taupo RSA Club (Inc). Your application will be considered at the next monthly meeting. Prior to confirmation (or otherwise) of your membership you are entitled to use the club facilities under the same rules and conditions as existing members.

A recent photograph is required with application.

Do you have any objections to this form being displayed on our notice board for information of our members.

Yes  / No  ________

Has your membership ever been declined, suspended or revoked from any other club?. If so please give reason.

_________________________________________________________________________________

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