SeniorNet Garden City - Membership Application Form

Click Here to Print this Membership Application Form

SeniorNet Garden City Inc.,
at rear of the Methodist Church car park, Cnr. Yaldhurst Road and Brake Street, Church Corner, Upper Riccarton, Christchurch
Telephone: (03) 348 4499
Membership Application Form

Please make Cheques payable to:	SeniorNet Garden City Inc.

Please post your Application enclosing your Subscription to:	SeniorNet Garden City Inc. Course Contact P.O.Box 6585 Upper Riccarton Christchurch 8442

APPLICATION FOR NEW MEMBERSHIP
Please Print Carefully

Surname:.......................	First Name:....................	Title:........
Surname:.......................	First Name:....................	Title:........
ADDRESS :	Street:	Phone No:
	Suburb:
	Town/City:	Postcode:
Email Address :	_______________________

The membership subscription on joining is $30.00 (Couple $55.00) Current to 31st March 2011

I/We certify that I/we am/are 50 years of age or older and I/we also agree to my/our personal details given above being entered onto the SeniorNet Garden City database.

Signed:.................................................................................. Date:......................

To enrol, please print this form, complete, sign and post to the address given above.
For details of Courses and Course Fees payable, please check the Course and Course Application form pages.

FOR OFFICE USE ONLY:

Subscription Paid: $..................... Date:.........................