Online membership form - Helensville Golf Club

Yes

Visitors

Membership Form

First Name*

Last Name*

Gender*

Male Female

Home Phone Number*

Work Phone Number

Fax 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*

Emergency Contact (Name and mobile number)

Emergency Contact (Relationship to the Applicant)

Privacy Statement: The information collected in this form will be used in accordance with the principles of the Privacy Act of 1993. The information will not be used for any other purpose than for a lawful purpose connected to the Club. Also you agree to abide by the laws and by-laws of the Helensville District Golf Club Inc. and by the rules of golf as laid down by the Royal & Ancient Golf Club of St. Andrews. By submitting this form, you acknowledge your rights to view and amend the information and agree to abide by these rules.

Please tick:

	ADDRESS:
	197 PEAK ROAD
	HELENSVILLE
	NEW ZEALAND
	PHONE:
	+64 (9) 420 5454
	EMAIL:
	manager@helensvillegolf.co.nz