Form 2: Membership Application

Form 2: Membership Application Form
Fill in this form to apply to become a member of Cesky Fousek New Zealand. The information will be sent to the Executive Committee for consideration.

Please take the time to complete this form accurately and fully so that we can consider your submission promptly without having to request further information.

"*" indicates required fields

Date*

DD dash MM dash YYYY

First Name*

Surname*

Physical Address*

Postal Address*

Home phone*

Cell phone*

Enter 'none" if you do not have a cell phone.

Email 1*

Please enter your primary email. This will be the primary means of communication.

Email 2*

Please enter your secondary email or enter "none".

Names of partner and children (optional)

Registered name of your Cesky Fousek

Applies to Full members only.

Membership Type:*

(Individual $25)

Your reasons for joining CFNZ*

Do you agree to the Purpose and Principles of CFNZ?*

See CFNZ Principles and Purposes

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