Nomination for Associate Membership Form

Name: Lindsay Grenfell
Email: lindsaygrenfell48@gmail.com
Address: 2 Jubilee Street, Dunedin. 9011
Home: 0212025537 (Lindsay)
Mobile: 0211529406 (Catherine)
Occupation: None
Date of Birth: April 9, 9 1948
Marital Status: Married
Spouse / Partner’s Name: Catherine Grenfell
Branch: Dunedin

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 Returned Serviceman/Servicewoman
for membership of the association. We believe this person to be a fit and proper person,
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: ________________

RSA Returned / Service Application

Service Number: T18371
Service: Navy
Units: Ashore and Afloat. RNZN Naval Hospital. HMNZS Tamaki, Philomel, Endeavour, Tui, Kiama, Canterbury, Waikato, Southland. ANZUK Military Hospital, Changi, Singapore. 1973-1975.
Length of Services: 1965-1990
Rank: CPOMA
Theatres of Service and Dates: NZ Services Medical Team, South Vietnam. 11/68 – 12/69
Medals and Awards: NZ Operational Service Medal. Vietnam Medal. NZ General Service Medal. Long Service Good Conduct Medal, NZ Defence Service Medal, South Vietnam Campaign Medal.
Any other Relevant Services Information . Are you receiving any financial assistance from War Pension Services? Yes
Would you like the RSA Welfare Officer to contact you? Yes

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: _______________ (if applicable)


Copy to Welfare Officer date _______________ (all successful applications)
Application complete – Secretary signature ____________ Date ____________

Please return to P.O Box 4008, St Kilda, Dunedin