KAIPARA EQUINE DRIVING CLUB

Membership Application Form
1st November 2008– 31st October 2009

 

Full Name/Names                                           Date of Birth
                                                                           (optional)

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Address:

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Phone:____________________________

Email:_____________________________

Other Contact Ph. Number____________________________________

Single Membership $20.00 / Family Membership $30.00

Subs Amount________________ Payment Date____________________

Cheque/Cash ___________________

Signed____________________________________ Date____________