Nomination for Associate Membership Form

Name Darwin
Address mintal davao city, Suite number, intersection, plaza, square
Home 123
Mobile 123
Occupation carpenter
Date of Birth April 18, 18 1982

Declaration: I hereby apply for membership of the Dunedin Returned and Services’ Association
and certify that the information given herein is correct. I undertake to abide by the Constitution
and Rules of the RSA. I have never been expelled or rejected from membership of any other
branch of the Returned and Services’ Association organisation.

Proposition:We, the undersigned, being financial members of the Dunedin Returned
and Services’ Association, hereby nominate the above named applicant for membership
of the association. We believe this person to be a fit and proper person, of good character,
and possessing the necessary qualifications for membership.

Proposer: How long have you known the applicant? __________________ years

Proposed by: ____________________ Signed:________________ Date: ________________

Seconder: How long have you known the applicant? __________________ years

Seconded by: ____________________ Signed:________________ Date: ________________

Committe use only

Date application received: __________________________

Committee Members to Initial: 1.) ______________ 2.) ______________

Accepted/Declined Accepted/Declined
(delete as applicable) (delete as applicable)

Committe use only

Letter sent date:________________

Amount due: ______________ Amount Payed: ______________ Date: _______________

Card Number: _______________________ Card and Badge sent date: ______________________

Application complete – Secretary signature ___________________________ Date ______________________