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Application Form

 

     

    

Membership Application Form 2006/2007

          I hereby apply for Annual/Life Membership

          Please complete the following contact information:

First name
Last name
Postal address
Address (cont.)
City
State/Province
Zip/Postal code
Country
Home Phone
E-mail
Callsign

          Please provide the following ordering information:

BILLING
Credit card
Cardholder name
Card number
Expiration date

         Select any of the following options that apply:

Entrance Fee                     NZ$     5.00           
Annual Subscription          NZ$   20.00
Life Membership               NZ$ 500.00
Callbook                             NZ$   10.00
Overseas Postage            NZ$      5.00

          Would you like your details in the Callbook

Yes No

          Are you a member of a CB Club

Yes No     (If Yes enter club)

WHAT YOU RECEIVE AS A MEMBER

Notice of meetings, Agendas, remits, newsletters, news as it occurs, Association help, Postal voting if not attending meeting, full speaking and voting rights if registered and present at a meeting - Access to members of the Association Council. Eligible to stand for the Association Council.

Annual Member:        Receives an Exclusive Gold Annual Badge

Life Member:              Receives an Exclusive Black Life Badge

 

This form can be completed, printed (your print button) and then posted to CBRANZ, 203 Ravensbourne Road, Ravensbourne, Dunedin, New Zealand along with your payment.
 
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Last updated: 16th January 2008