Join | Timaru South Cosmopolitan Club

Timaru South Cosmopolitan Club Membership Application

Members are entitled to a free meal up to $25 on their birthday, provided you bring two extras to dine with
On AGM day, all members who attend are entitled to one free jug, RTD, wine, or soft drink
Upon joining, members also receive a president's shout, which entitles you to another free drink

Membership Typeplease select one

Ordinary (18+)Couple (18+)Junior (15-18)

I verify that I am 18 years of age or older

Yes

Which other way?

Applicant

Titleplease select one

MrMrsMissMs

Partner's Titleplease select one

MrMrsMissMs

First Namesyour first name

Partner's First Namesyour partner's first name

Last Nameyour last name

Partner's Last Nameyour partner's last name

Have you ever been known by another name?

YesNo

What other name?

Addressyour home address

Home Phoneyour home contact number

Mobile Phoneyour mobile number

Partner's Mobile Phoneyour partner's mobile number (if applicable)

Emaila valid email

Partner's Emailyour partner's email (if applicable)

Date of Birthwhen were you born

Partner's Date of Birthwhen was your partner born

Occupationwhat do you do for a job

Partner's Occupationwhat does your partner do for a job

Has your membership ever been declined, suspended or revoked from any club?please select one

YesNo

Club Name and Detailsdetails of the club

Privacy Act 1993

The above named Club is collecting and will hold the information on this form. The Club is collecting the information:

So it and its Members can assess the applicant�s suitability for Membership (including transfers for Membership):
So it can administer it�s operation and assist other Clubs that are Members of Clubs New Zealand to administer theirs;
To enable Clubs New Zealand or its agent to compile a list of members of all Clubs in New Zealand and to send those Members promotional, marketing and other material.
Your name will be posted on the Club Notice Board for 14 days prior to a Committee meeting.
The applicant acknowledges by signing this form that he or she has authorized the Club to obtain, check, exchange information with and supply information to Members of the Club, Clubs New Zealand and other Clubs that are Members of Clubs New Zealand.
The applicant is entitled, under the Privacy Act 1993 to have access to and request correction of personal information held by the Club about the applicant.

I hereby agree to abide by the rules and constitution of the Club and certify that the above information is correct.

I acknowledge that if I have given false information, it will result in automatic cancellation of Membership.

I enclose $5.00 being full payment of the nomination fee (Non Refundable).

Membership Details

I agree to the terms and conditions

Yes

Commentsmore details

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