Feilding & District Steam Rail Society Inc - Intranet
New Membership
New Membership
Membership runs from 1st July until 30th June the year after.
First Name
*
Last Name
*
Spouse / other
Contact No.
Street Address
Suburb
City
-
Feilding
Palmerston North
Levin
Ashhurst
Wanganui
New Plymouth
Upper Hutt
Otaki Beach
Paraparaumu
Bulls
Marton
Dannevirke
Pahiatua
Masterton
Foxton
Shannon
Bunnythorpe
Inglewood
Whitby
Lower Hutt
Waitaere
Porirua
Matamata
Kaitaia
Hunterville
Waikanae
Tokoroa
Rongotea
Christchurch
Wellington
Otaki
Papatoetoe
Foxton Beach
Waipukurau
Woodville
Ohakea
Australia
Tamumarunui
Hawera
Ahaura
Ahipara
Auckland
Dunedin
Waitakere
Hamilton
Greymouth
Napier
Napier
Kaiwaka
Petone
Te Awamutu
Kapiti
Invercargill
Thames
Mangaweka
Kairanga
Taupo
Post code
Landline No.
*
Cell Phone No.
*
Date of Birth
*
Driver Licence No.
Expiry Date:
First Aid Cert
Expiry Date:
Occupation
E-Mail Address
*
Type of Membership please (Click one)
*
Ordinary Member $30
Family Member $40
(2 Adults & 2 Children)
Junior Member $15
(under 18)
Comments
Payment Details
Payment was made by:
*
Cash
Bank deposit
Cheque
Bank Deposit details
Account Name:
FDSR
Account Number:
03-0626-0659376-000
Please use your First name & surname as a reference and return this completed form if you printed this form.
*
Are required feilds, please make sure you have filled these in.