Become a Member – Raetihi Cosmopolitan Club

Name*
First Last
Date of birth*
MM slash DD slash YYYY
Phone*
Email*
Occupation*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Postal Address (if different from residential address)
Proposer*
Proposer Member Number*
Seconded*
Seconded Member Number*
Membership Fees*
New membership fees may change depending on the time of the year. Senior Memberships are for those over 60 years old and cost $35 a year. Standard Memberships are for 18-59 years old and are $60 a year. Junior membership are available, please see the club for more information. To pay your membership application please come into the club or make a bank deposit. Acc no. 02 0792 0086331 000 Reference: Your name
Consent*
I, the candidate for Membership, am over the age of 18 and hereby consent to such nomination and if I am accepted as a member of the Raetihi Cosmopolitan Club agree to abide by the rules of the club. I also understand that my application will not be processed till payment of membership fee is received.