CF7

Membership Application Form

New Brighton Club Incorporated

Mr/Mrs/Miss/Ms: Miss Surname: main
Name alexis
Address 23 main soUtH road
Contact Telephone 3489324
Mobile 0221644047
Email akexis_main1@outlook.com
Occupation famIlY store
Date of Birth 18/09/1991
Are you, or have you ever been known by another name? Yes
If YES, please write your name in full alexis jain main
Membership Pack Posted? Pickup? Posted

Further Important Details

Office Use Only

Name: main, alexis Address: 23 main soUtH road
Date: 19/11/2020                        Date to:                         Amount:        Membership:

Privacy Act 1993. The Club is collecting, and will hold, the information on this form.

The information is required:

  • So it and its members, can assess the applicants suitability for membership (including transfer of membership)
  • So it can administer it’s operation and assist other Clubs affiliated with Clubs New Zealand to administer theirs

Following the Rules Committee Meeting your name will be displayed on the Club Notice Board for 7 clear days. 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 of New Zealand and Clubs that are members of Clubs New Zealand. 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 information provided on the application form is correct. I acknowledge that if I have given false information, it could result in automatic cancellation of my application and/or membership. I certify that I am not suspended or expelled from another Club.

SIGNATURE ***SIGNED ELECTRONICALLY*** Date: 19/11/2020