Important Note for Ian

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Membership

Type of Membership	Criteria	Cost
Personal	Must be at least 18yrs of age	$150.00
Family	Covers 2 Adults (partners) and dependents up to 18 years of age	$200.00
Student	Valid Student to be provided at time of application	$80.00
Senior/Gold	Must be >60 years old & been a concurrent paid member for 5 years	$80.00
Life	Covers Personal Membership + Family (immediate) Membership	$2,000.00

Membership is valid until 30th June the following year.

Membership Fees are prorated through the year e.g. joining date is 8th September = 10/12 of applicable fee is payable.

All Membership fees are inclusive of GST.

Membership Form

Membership Application Form

I hereby agree to abide by the Club’s Rules and Code of Conduct posted on the Club’s website (churchillclub.co.nz). I certify that the information provided on this application form is correct. I acknowledge that if I have given any false information, it could result in automatic cancellation of my application and / or membership. I declare that I am at least 18 years of age.

Proposer First Name

Proposer Last Name

Proposer Membership Number

Seconder First Name

Seconder Last Name

Seconder Membership Number

Privacy Act 1993

The Club is collecting and will retain the information on this form. The information is required:

(a) so it and it’s members, can assess the applicant’s suitability for membership

(b) so it can communicate and contact the members of the club as required

First Member Details

First Name

Last Name

Date of Birth

Phone Number

Occupation

Address

Address Line 1

Address Line 2

City

Postcode

IMPORTANT

You must send a copy of your valid Student ID to membership@churchillclub.co.nz in order for us to process your application.

Important Note for Ian

Membership

Membership Application Form

First Member Details

Club Hours

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