Membership Senior Form
MURIWAI VOLUNTEER LIFEGUARD SERVICE INC.
P. O. Box 526, Kumeu,
SENIOR CLUB SUBSCRIPTION INVOICE
or
Name: ……………………………………………………………………………………
Address: ……………………………………………………………………………………
(street)
…………………………………………………………………………………….
(suburb)
…………………………………………………………………………………….
(town) (please include Postcode – SLSNZ requirement)
DOB: ………………………………
Home Ph: ………………………………
E-mail: ……………………………………………………………………………………..
Your subscription for the 2008/2000 season is due by 1 November 2008. Please tick the appropriate category below and make cheques payable to:
Muriwai Volunteer Lifeguard Service, PO Box 526, Kumeu, 0841
Or pay online Acc # : 12-3053-0322971-00 (remember to put name in reference field)
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Status |
Amount |
X |
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Senior Competitive |
$100 |
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Senior Active (Lifeguard) |
$50 |
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Junior (U19) Competitive |
$70 |
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Junior (U19) Active (Lifeguard) |
$30 |
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Master Competitive |
$50 |
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Senior Family (each member must complete a membership form) |
$250 |
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Associate |
$30 |
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100 Sponsors Club |
$100 |
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TOTAL PAID (incl. GST) |
$ |
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Cheque / Internet Banking (circle one)
Office Use Only:
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SLSNZ Form Completed |
Receipt Issued |
Membership Card Issued |
Database Updated |
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New Members:
Please supply a list of your qualifications to date:
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Qualification |
Date Last Refreshed |
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Renewing Members:
To update the SLSNZ database please supply the following Emergency Contact details:
Name: ……………………………………Relationship: ………………………
Address: ………………………………………………….
………………………………………………….
Home Ph: ……………………