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
I verify that I am 18 years of age or older
How did you learn of the advantages of Timaru South Cosmopolitan Club Membership?please tick one or many
Which other way?
Titleplease select one
Partner's Titleplease select one
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?
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)
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
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 applicantís suitability for Membership (including transfers for Membership): 
  • So it can administer itís 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
Membership Fee1[field3]
Nomination Fee1[field26]
I agree to the terms and conditions
Commentsmore details
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