Nomination for Associate Membership Form

Name: Wendy Ross
Email: maddcow69@hotmail.com
Address: 109 Quarry Road, Kinmont Park
Home: 0272435021
Mobile: 0272435021
Occupation: Teacher
Date of Birth: February 28, 28 1969

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 ____________