The $25 Nomination Fee Also Includes Their Subscription to 31st October 2017

I
,
,
of
Phone:
E-Mail Address: *
Date of Birth: *

Privacy Act 1993.

  1. The above named club is collecting, and will hold, the information on this form. The club is collecting the information:

    1. so it, and its members, can assess the applicants suitability for membership (including transfers of membership);
    2. so it can administer its operation and assist other clubs that are members of New Zealand Chartered Clubs Incorporated (NZCC) to
      administer theirs;
    3. to enable NZCC 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.
  2. Details of this application will be displayed on the club notice board prior to acceptance as a full member.
  3. The applicant acknowledges by signing this form that he or she has authorised the club to obtain, check, exchange information with, and supply information to, members of the club, NZCC and other clubs that are members of NZCC.
  4. 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.


Details of any disciplinary actions by another club
Details of any criminal convictions


I hereby agree to abide by the rules 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 $50.00 being full payment of the nomination fee and annual subscription until the end of the next financial
year.

yes Tick the box if you do not agree to being sent material described in 1c above

Proposers:
We support this application for membership of the Kamo Club Inc. and consider the applicant is a
suitable person to become a member.

I have known the applicant for years.
Member No:

I have known the applicant for years.
Member No:

Partners Name:
Sports Interests:


CLICK HERE TO OPEN THE KAMO CLUB RULE BOOK IN A SEPARATE WINDOW
yes I have read and agree to comply to the RULES OF THE KAMO CLUB stated in the KAMO CLUB RULE BOOK.


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