Nomination for Associate Membership Form

Name: Chris Hay (Ex – 2 Scots, RNZAC)
Email: chris.hay@otago.ac.nz
Address: 21 McTaggart Street, Company Bay, Dunedin, 9014
Home: 03 476 1735
Mobile: 021 1599856
Occupation: Lab Technician
Date of Birth: Array Array, Array Array

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 ____________