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Nomination Form for Membership

 A Fee of $25.00 is required with this form.

Club Rules

 

Raetihi Cosmopolitan Club (Inc)

P.O. Box 38, Raetihi 4646

 

We, the undersigned, being finanical members for one year of the Raetihi Cosmopolitan Club, hereby nominate the following as a member of the Club.

 

NAME IN FULL (please print)……………………………………………………………………………

 

Date of Birth (year not required):

 

DAY…………..Month…………or, I am over/under 60 year of age. (please delete as appropriate)

 

Contact Phone Number:………………………………………......Mobile:……………………………

 

Email Address:……………………………………………………………………………………………

 

Occupation:………………………………………………………………………………………………

 

Full Residential Address:…………………………………………………………………………………

 

Proposer (please print): ………………………………………………………… Membership No:……

 

Seconder (please print): ………………………………………………………… Membership No:……

 

Name of Committee Member/Manager (please print):…………………………………………………….…

 

Signature of Committee Member/Manager:…………………………………………………………………

 

 

1, the candidate for membership, am over the age of 18, and hereby consents to such nomination and if I am accepted as a member of the Raetihi Cosmopolitan Club agree to abide by the rules of the Club.

 

 

Signature of Candidate:…………………………………………………DATE:  ……/…………/….......

 

 

---------------------------------------------FOR OFFICE USE ONLY----------------------------------------------

 

 

A Fee of $25.00 is required with this form.

 

Date:…………../……………../……………..                                        Receipt Number:………………

ID Type:………………………………………..                                        ID Number:…………………

Staff Name (please print):………………………………………    Staff Signature: ……………………

 

APPROVED/DECLINED   Signed …………………………….......... (President) DATE…. ./……/…….