Half Year Membership Form 2011/2012
Items marked * are compulsory.
Mount Maunganui Underwater Club Inc.
PO Box 5193, Mt Maunganui
Applicant Details
Application Type
*
New Membership OR
Renewal
First Name
*
Surname
*
Address
*
Please include full postal address including postcode.
Personal Phone
*
Alternative Phone
Work Phone
Email Address
*
Membership Details
Membership Type
*
Social OR
Active Diver - Enter qualification
Diver Interests
Hunter-Gatherer
Photography
Sightseeing
Wreck Dives
Adventure Dives
Spearfishing
Newsletter Preference
*
Email
Post
No Newsletter
Half Year Subscriptions
*
1 Dec '11 to 30 Jun '12
Family $50 All children under 16 years
Couple $45
Single $35 16 years and over
Junior $15 Under 16 years
Spouse/Partner Details
Family/Couple Membership Only
First Name
Surname
Membership Type
Social OR
Active Diver - Enter qualification
Children
Family Membership Only
Childrens Names
Please include birth dates for all children listed (not ages).
*
I/We hereby agree to abide by the rules and regulations of the Mount Maunganui Underwater Club Inc and the Mount Ocean Sports Club Inc. I/We agree to the club's making any inquiry from any source concerning my/our suitability for membership.