Online membership form - Waikanae Golf Club

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Online Membership Form

Membership Form

First Name*

Last Name*

Gender*

Male Female

Home Phone Number*

Work Phone Number

Mobile Phone Number

Address Line 1*

Address Line 2*

City*

Post Code*

Email Address*

Date of Birth

Are you currently a member or have you ever been a member of a Golf NZ affiliated golf club? Yes

Membership Number

Occupation*

Introduced By (Member):

Are you a New Zealand Citizen?*

Yes No

Membership Type Requested*

Do you have any serious medical conditions that you’d like the club to be aware of?*

Emergency Contact Name & Number

Please expect a call from us to book in your welcome and club introduction tour with our GM Chris Judd. I understand that in order for my application to be progressed I need to have my welcome and club introduction tour booked with the General manager

Privacy Statement: The information collected in this form will be used in accordance with the principles of the Privacy Act of 2020. The information will not be used for any other purpose than for a lawful purpose connected to the Club. By submitting this form, you acknowledge your rights to view and amend the information. As a member of Palmerston North Golf Club, you agree to all rules, conditions and playing privileges that apply to your membership.

Please tick:

	Address: 97 TE MOANA ROAD WAIKANAE NEW ZEALAND
	Phone: +64 (4) 293 6399
	Email: office@waikanaegolfclub.co.nz