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Application for Membership of the Raglan Club Incorporated P.O. Box 53, Raglan Phone: Office: 07-825 8288 Fax: 07-825 7488
APPLICANT
Surname Forename(s) ..............
Are you or have you been known by any other name YES / NO
If YES, what .....
Address: ..
Contact telephone number .Date of birth / .../ .. Male / Female
Has membership ever been declined, suspended or revoked from any other Club? YES / NO
If YES name of Club and details
Privacy Act 1993
1. The above named Club is collecting, and will hold, the information on this form. The Club is collecting the information; a. so it, and its members, can assess the applicants suitability for membership (including transfers of membership) b. so it can administer its operation and assist other Clubs that are members of New Zealand Chartered Clubs Incorporated (Clubs NZ) to administer theirs; c. To enable Clubs NZ or its agent to complete a list of members of all clubs in New Zealand and to send those members promotional, marketing and other material.
2. 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 NZ and other clubs that are members of Clubs NZ.
3. 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 of the club and certify that the above information is correct. I acknowledge that if I give false information, it will result in automatic cancellation of membership. I enclose $20.00 being full payment of the nomination fee.
Tick the box if you do not agree to being sent material described in 1c above.
../ ../ .. (Signature of applicant) (Dated)
On acceptance as a member of the Club the applicant shall receive an account for the current years subscription, which is to be paid within 14 days. If payment is not within this period the membership becomes invalid. Temporary membership expires on this date. Names of candidates for election to membership are posted on the Club notice board for a period of at least 14 days and any existing member may object in writing. A majority of the executive must approve election of members.
Both the proposer and seconder agree to be responsible for the candidate for the ensuing 12 months. Proposer and seconder must have been a member of the Raglan Club for at least 12 months.
We know the applicant personally and in accordance with the rules, recommend him/her for membership.
Proposer, I have known the applicant ........years (signature) (printed name) (Member No: )
Seconder, I have known the applicant ........years (signature) (printed name) (member No.)
Office use only
Date nomination received / / Date elected/declined / / Card ordered / /
Subscription paid .. Receipt no
Membership no
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