Wellington Branch New Zealand Deerstalkers' Association
Membership Application Form
To:
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Surname |
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Given Name/s |
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Preferred mailing address |
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Suburb |
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City / Post code |
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Occupation (optional) |
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Telephone |
Hm Wk | |
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Cell phone | ||
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Email Address: |
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Do you wish to receive the NZDA Monthly newsletter electronically? Yes / No Do you wish to receive the Branch monthly newsletter electronically? Yes / No | |
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Family (please see over page for more information) |
Name:____________________ | |
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Are you a holder of a current firearms licence ? YES / NO Have you ever been convicted of any firearms offences ? YES / NO | ||
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Date of Birth if Junior or Superannuant |
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Junior less than 18 as at 1 March 2010. |
The membership type I am applying for is: (please circle one)
( For information and requirements on categories see Membership Benefits )
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FEES |
Full Year Mar to May |
3/4 Year Jun to Aug |
1/2 Year Sept to Nov |
1/4Year |
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SENIOR |
$86.00 |
$66.50 |
$47.00 |
$27.50 |
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JUNIOR |
$39.00 |
$30.00 |
$21.00 |
$12.00 |
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ASSOCIATE. |
$45.50 |
$34.88 |
$24.25 |
$13.63 |
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AFFILIATE |
$30.00 |
$22.50 |
$15.00 |
$7.50 |
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Friend of the Branch |
$20.00 |
$15.00 |
$10.00 |
$5.00 |
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STUDENT: |
$64.00 |
$48.75 |
$33.50 |
$18.25 |
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SUPERANNUANT : |
$64.00 |
$48.75 |
$33.50 |
$18.25 |
Please find enclosed my payment for my application to Wellington Branch.
Or charge to my:
Mastercard Visa
Card Number:
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Expiry Date: _ _ / _ _
Name of Card Holder :
Under the terms of the Privacy Act 1993, I acknowledge that you are retaining my name and club details for the purpose of mailing further information on NZDA and related matters.
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Signature: |
Date: |
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For office use only: |
AS |
A |
C |
DU |
Contact: Bruce
| Phone: | 04-476 4080 | PO Box 2148 | ||
| Email: | harkness20@paradise.net.nz | |||
| Wellington |