Go to the printer-friendly (PDF) form (Print it then post to:-)
The Secretary, PO Box 20 295, Bishopdale, Christchurch

I/we hereby apply for FBNZ membership - name(s):

Applicant:____________________________________ 

Occupation:__________________________________

Partner:______________________________________ 

Occupation:__________________________________

Address:_____________________________________

              _____________________________________

              _____________________________

Phone:_________________ Fax:_________________

 email:_______________________________________

Accompanying Children:-

1:__________________________ DoB:____/____/____

2:__________________________ DoB:____/____/____

3:__________________________ DoB:____/____/____

4:__________________________ DoB:____/____/____

Date of birth: Applicant:____/____/____ Partner:____/____/____

How would you prefer the newsletter to be sent?  Email____ Post_____ (tick one)

Do you wish to be included in the 'Contact List'?      Yes____   No____ (tick one)

Are you a current member of a Naturist Club?          Yes____   No____ (tick one)

If 'Yes', please specify each of them: ______________________________________

The initial year's subscription of $20 is enclosed.     Yes____   No____ (tick one)

The subscription has been paid direct to ASB 12-3011-0822353-00 (Date:___/___/___)

The information which you supply on this Application Form will only be available to
Officers of the Club's Committee. You may request that it be changed at any time.

Please read next section before signing.
 

Signature Applicant:__________________________ Date:____/____/____
 

Signature Partner:____________________________ Date:____/____/____
 

Privacy Act 1993

In accordance with Information Privacy Principle 3 of the Privacy Act 1993,
the purposes of the information supplied on this Application Form are:-

ITEM                                          PURPOSES

Full Name(s)                               To identify the applicant.

Occupation(s)                             Required by the Incorporated Societies Act 1908.

Residence/Address                     To post the newsletter, etc (and an Act requirement).

Home Phone Number                  To communicate with the applicant for activities. 

Children & DoB                           To help plan family activities.

Date of Birth                                For statistical purposes.

Club Membership                        Required to calculate the fee for the New Zealand Naturist Federation.