Ōtaki and District Memorial RSA Inc

trading as the Ōtaki Community Club and RSA

APPLICATION FOR MEMBERSHIP

First names

SURNAME, or FAMILY name

Known as

Occupation

Address

Date of birth – membership fees are age dependent.

Phone Number landline

Phone Number Mobile

Do you wish to receive regular emails such as newsletters?

Yes

I apply for membership of the Ōtaki and District Memorial RSA Inc, and I Declare that the information supplied is true and correct, and if admitted for membership I will agree to be bound by the RSA’s constitution and rules available at the Ōtaki RSA office and on line at www.otakirsa.co.nz

Signature

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Date

You can pay at the club using;

Eftpos
Deposit to our bank account 03-1532-0029052-00.
Please use your name as the reference.