KATIKATI BOWLING CLUB (Inc)

8 Park Road                                                                            Ph: (07) 549 0103

KATIKATI 3129                                             E-mail: katikatibowlsAgmail.com

APPLICATION FOR MEMBERSHIP

Section 1 — Personal Details

Mr/ Mrs Ms Miss/Other .............  Surname..................................................

Christian Names:.........................................................................................

Address: .....................................................................................................

...................................................................  Postal Code: .........................

Telephone No. (Home): ...........................  Mobile: .....................................

E-mail address: ..........................................................................................

Date of Birth: (Optional) ...........  Gender: M / F Occupation: .......................

Section 2 — Types of Membership (please tick one)

Full Member 0              Casual 0                Associate 0            Non Playing 0

I have played bowls for.. Years and am currently graded as.......................

Section 3 — Registration

.......................................................................................... desire to become a member of the Katikati

Bowling Club (Inc). I declare that the information on this form is true and correct and that I will abide by the Club Constitution, Rules and Code of Conduct. I am aware that a copy of these can be obtained from the Club Secretary.

Dated this...................... day of......................................... 20........................

Signature of Applicant: ................................................................................

Nominated by:...................................... Seconded by: .................................

Privacy Statement: The Katikati Bowling Club (Inc) collects information about you from the information you provide in seeking membership of the Club. This information is also provided to Bowls Bay of Plenty and Bowls New Zealand as per our constitution. You have a right to inspect your personal information held by the Club. Your personal information may be used by the Club for marketing services to improve our Club.

If you do not wish to receive marketing material and information please tick here: Office Use:

Date Joined................... Date Approved...................... Clearance Certificate Provided

Receipt No ......................  Membership No.................... Yes 0                   No    0