Membership Form

First Name

Last Name

Email Address

Mobile Phone Number

Home Phone Number

Work Phone Number

Full Postal Address

Postcode

Date of Birth (DD/MM/YY)

Occupation

Gender Gender *MaleFemale

Are you currently a member or have you ever been a member of a Golf NZ affiliated golf club? Are you currently a member or have you ever been a member of a Golf NZ affiliated golf club? YES NO

Do you wish Napier to be your Home Club? Do you wish Napier to be your Home Club? YES NO

Membership Number

Introduced By (Member):

Membership Type Requested* Membership Type Requested* *Full Playing9 HoleFull Playing U40Full Playing U35Full Playing U25Fulltime StudentSocial MemberRestricted U14Summer 18 HoleSummer 9 Hole18 Hole Half Summer Only

Are you a New Zealand Citizen?* Are you a New Zealand Citizen?* YES NO

Emergency Contact Name*

Emergency Contact Number*

Privacy Statement Privacy Statement The information collected in this form will be used in accordance with the principles of the Privacy Act 2020.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.

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