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HOME Waihi Beach Memorial RSA (Inc) P.O. Box 44 Waihi Beach
Application for Associate Membership
Surname:_________________________ First Names:___________________________________
Known as:_________________________________
Proposed by________________________________ Membership No:________________
Seconded by:_______________________________ Membership No:________________
Subscription: $40 Joining Fee: $40 Total $80
Applicants Address: Pin passport size photo here ______________________________________________
______________________________________________
Contact Phone:____________________________ Mobile:____________________________
E/Mail:_____________________________________________________________________
Date of Berth:_____________________________ Occupation:________________________
Next of Kin:_______________________________________ Relationship:________________
Address:____________________________________________________________________
I hereby to agree to abide by the club rules of the club and that the above information is correct
Signature of Applicant:______________________________________ Date:_______________
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