New Member Membership Application

Please complete the New Member Membership Application form below to become a member.

Name*
Name, Initials and Name known by Last
e.g. William, W S B, Bill.
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Email*
Phone*
Membership Subscriptions
2024 year Membership
Additional Family Members Quantity
Price: $ 10.00
Large Lapel Badge (includes Postage within New Zealand) Quantity
Price: $ 19.00
Large Lapel Badge (includes $26 Postage Overseas) Quantity
Price: $ 41.00
Small Lapel Badge (includes Postage within New Zealand) Quantity
Price: $ 14.00
Small Lapel Badge (includes $26 Postage Overseas) Quantity
Price: $ 36.00
Payment Details
Total NZ$
$ 0.00
Payment Method (if you are paying on behalf of someone else please include your Name as well as the Members as a reference)*
- Bank Transfer, by Internet or at your Bank Branch
- Credit Card / PayPal
Please credit your payment by internet banking to the NZR&LS bank account,
account no. 02 0500 0019277 00
If you have no Internet banking, print this page, fill in the identifiers and take it to your Bank Branch for payment.

Put the following in the bank transfer form:-

particulars | Your surname followed by initials

code | Word "New Member"

reference | Word "subscription"
Post Custom Field
Untitled
- First Choice
- Second Choice
- Third Choice
Section Break

Membership Subscriptions