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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 complete a form carefully for each applicant

Please make Cheques payable to:SeniorNet Garden City Inc.
If you prefer, you may Direct Credit your payment to our account :  02-0874-0215678-000
Please post your Application enclosing your Cheque
or confirmation of your Direct Credit (please tick box)   box to:
SeniorNet Garden City Inc.
P.O.Box 6585
Upper Riccarton
Christchurch 8442

Surname: First Name: Title:
Address: Street: Phone No:
Suburb:
Town/City: Postcode:
Email Address:
I use     Windows7      Windows 8.1      Windows 10 Please circle one
I use    Desktop   Laptop   Tablet      iPad     other   Please circle one

The subscription on joining is $20.00 Per Annum, January - December
New members joining Oct - Dec., Subscription is valid for following year
Current members are required to renew prior to 31st March
Course and Workshop Fees are additional and listed on the relevant pages

The following information is required by the Tertiary Education Commission
Please Tick Your Age Group:   50-54    55-60     61-65    over65
My Ethnic Group is:   Maori    NZ European     Asian     Pacific Island     Other    
I have Permanent Residency:   Yes    No    
Have you previously been a member of SeniorNet:   Yes    No    If yes, which centre?..................................

How did you hear about SeniorNet?..............................................................................

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


To enroll, please print this form, complete, sign and post with your Cheque to the address 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:.........................