Kamo Club Membership Form

All Memberships Renew Annually On October 31st

$75 Nomination Fee

Privacy Act 1993

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

• so it, and its members, can assess the applicants suitability for membership (including transfers of membership);
• so it can administer its operation and assist other clubs that are members of New Zealand Chartered Clubs Incorporated (NZCC) to administer theirs;
• 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.

Details of this application will be displayed on the club notice board prior to acceptance as a full member.

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.

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 have given false information, it will result in automatic cancellation of membership.

I enclose $75.00 or have paid into your ANZ Bank 06-0493-0004500-00 being full payment of the nomination fee and annual subscription until the end of the next financial year.

PROPOSERS: