Membership Junior form
MURIWAI VOLUNTEER LIFEGUARD SERVICE INC.
P. O. Box 526, Kumeu,
JUNIOR CLUB SUBSCRIPTION INVOICE
or
|
SURNAME |
FIRST NAME |
DOB |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Address: ……………………………………………………………
……………………………………………………………...............
(Please include Postcode – SLSNZ requirement)
Home Ph: ……………………. Work Ph: ……………………....
Family Email address: ………………………………………………………..
Muriwai Volunteer Lifeguard Service, PO Box 526, Kumeu,
or pay online Acc # 12-3053-0322971-00 (remember to put name in reference field)
|
ALL NEW MEMBERS MUST ALSO FILL OUT A SURF LIFESAVING NZ MEMBERSHIP FORM |
Amount |
X |
|
1 Child (U14) plus 1 adult (adult - circle one – Associate member / Active Lifeguard ) |
$100 |
|
|
Junior Family (Incl. all children and up to 2 adults) |
$150 |
|
|
(Adults: Name: Associate member / Active Lifeguard ) Name: Associate member / Active Lifeguard ) |
|
|
|
|
|
|
|
Senior Competitive |
$100 |
|
|
100 Sponsors Club |
$100 |
|
|
Clothing – as per clothing form |
|
|
|
TOTAL PAYABLE (Inc GST) |
$ |
|
Cheque / Cash / Internet Banking (please circle one)
Office Use Only:
|
SLSNZ Membership Completed |
Receipt Issued |
Membership Card Issued |
Database Updated |
|
|
|
|
|