Online membership form - Boulcott's Farm Heritage Golf Club

Membership

Online Membership Form

Membership Form

First Name*

Last Name*

Gender*

Male Female

Home Phone Number*

Work Phone Number

Mobile Phone Number

Address Line 1*

Address Line 2*

City*

Post Code*

Email Address*

Date of Birth

Are you currently a member or have you ever been a member of a Golf NZ affiliated golf club? Yes

Membership Number

Occupation*

Introduced By (Member):

Are you a New Zealand Citizen?*

Yes No

Membership Type Requested*

Privacy Statement: The information collected in this form will be used in accordance with the principles of the Privacy Act of 1993. The information will not be used for any other purpose than for a lawful purpose connected to the Club. By submitting this form, you acknowledge your rights to view and amend the information.

Please tick:

	ADDRESS:
	MILITARY ROAD, LOWER HUTT,
	WELLINGTON, NEW ZEALAND
	PHONE:
	+64 (4) 567 4722
	EMAIL:
	admin@boulcottsfarmhgc.co.nz