Nomination for Associate Membership Form

Name: Gerard Anthony Costello (Gerry)
Address: 185 Evans St, Opoho, Dunedin, 9010
Home: 027 433 7784
Mobile: 027 433 7784
Occupation: Contract Manager
Date of Birth: Array Array, Array Array
Marital Status: Array
Spouse / Partner’s Name: Julie Anne Costello
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: G186260
Service: Array
Units: 2 NZ Scots, NZ Scots, 2/4 Infantry Battalion, HQ NZDF.
Length of Services: 32 years
Rank: WO1
Theatres of Service and Dates: Timor, May – Nov 2000. (NZBATT 2)
Medals and Awards: NZ Defense Service Medal, UN Service Medal, NZ Overseas Service Medal, East Timor Medal. CGS Commendation award.
Any other Relevant Services Information Gerry’s final posting was Army Reserve Sergeant Major NZ. 2013-2018. Dates TBC. Are you receiving any financial assistance from War Pension Services? Array
Would you like the RSA Welfare Officer to contact you? Array

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