HOME              CAMBRIDGE COSMOPOLITAN CLUB (INC)

88-94 Burns St                                                                                                 Phone:  (07) 827-7006

P O Box 373                                                                                                    Fax: … (07) 827-7368

CAMBRIDGE      

NEW  MEMBER  APPLICATION  FORM

MEMBERSHIP CATEGORY: Ordinary / Senior / Associate / Junior

Has your membership ever been declined, suspended or revoked from any Club    YES / NO

If Yes, please provide name of club and details...................................................................................

PRIVACY ACT 1993 DISCLOSURES

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

A)    So it can administer its operation and assist other clubs that are members of Clubs NZ Inc to administer theirs

B)      To enable Clubs NZ Inc, 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.

1.       The new member 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, Clubs NZ Inc. and other clubs that are members of Clubs NZ Inc.

2.       The new member is entitled, under the Privacy Act 1993 to have access to, and request correction of, personal information held by the club about the applicant.

PROBATIONARY PERIOD

The new member acknowledges that they have been provided with a receipt for membership to the Club premises and a copy of Constitution and Rules.  For a period not exceeding 31 days the new member does not enjoy the rights and privileges of the membership category for which they are applying until their permanent card is issued.

I hereby agree to abide by the rules of the club and certify that the above information is correct and I have read and understand the above conditions I acknowledge that if I have given false information, it will result in automatic cancellation of membership. 

*** Annual Subscriptions are currently Ordinary $50.00 - Ordinary Senior (Over 60 years) $40.00 - Associate (limited visits) $25.00 - Junior $20.00 - and the relevant amount should be submitted with this application.

(Signature of New Member) …………………………………..                     (Date) ………………………………………

………………………………………………………..…..

GARY PENNELL (Secretary / Manager) or his agent