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The Secretary, PO Box 20 295, Bishopdale, Christchurch, 8543

I/we hereby apply for FBNZ membership - name(s):







              _____________________________________   P.Code: ________

Phone:_____________________________ Mob:_______________________


Accompanying Children:-

1:__________________________ DoB:____/____/____

2:__________________________ DoB:____/____/____

3:__________________________ DoB:____/____/____

4:__________________________ DoB:____/____/____

Date of birth: Applicant:____/____/____ Partner:____/____/____

How would you prefer the newsletter to be sent?  Email____ Post____  (tick one)

Do you wish to be included in the 'Contact List'?      Yes____   No____  (tick one)

(The Contact List is only available to those listed in it.)

Are you a current member of a Naturist Club?          Yes____   No____  (tick one)

If 'Yes', please specify each of them: ______________________________________

The initial year's subscription of $30 is enclosed.     Yes____   No____   (tick one)

The subscription has been paid to KiwiBank: 38-9014-0140590-00 (Date:___/___/___)

The information which you supply on this Application Form will only be available to
Officers of the Club's Committee. You may request that it be changed at any time.

Please read next section before signing.

Signature Applicant:__________________________ Date:____/____/____

Signature Partner:____________________________ Date:____/____/____

Privacy Act 1993

In accordance with Information Privacy Principle 3 of the Privacy Act 1993,
the purposes of the information supplied on this Application Form are:-


Full Name(s)



Home Phone Number

Children & DoB

Date of Birth

Club Membership

To identify the applicant.

Required by the Incorporated Societies Act 1908.

To post the newsletter, etc (and an Act requirement).

To communicate with the applicant for activities.

To help plan family activities.

For statistical purposes.

Required to calculate the fee for the New Zealand Naturist Federation.