Online membership form - Raglan Golf Club

Yes

Online Membership Form

Membership Form

First Name*

Last Name*

Gender*

Male Female

Home Phone Number*

Work Phone Number

Fax Number

Mobile Phone Number

Address Line 1*

Address Line 2*

City*

Post Code*

Email Address*

Date of Birth

Are you currently a member or have you ever been a member of a Golf NZ affiliated golf club? Yes

Membership Number

Occupation*

Introduced By (Member):

Are you a New Zealand Citizen?*

Yes No

Emergency Contact Name

Emergency Contact Number

Privacy Statement: The information collected in this form will be used in accordance with the principles of the Privacy Act of 1993. The information will not be used for any other purpose than for a lawful purpose connected to the Club. By submitting this form, you acknowledge your rights to view and amend the information.

Please tick:

Subscription fees – can be paid in advance fortnightly, monthly or annually

Account number for payment – Raglan Golf Club 03 1563 0028327 00 Indicate your name with online payment

	Address: Te Hutewai Rd, Raglan, NZ
	Phone: 07 825 8483