MMLS Membership Application form

Application for Membership

*Please note for Junior Surf Membership (5 - 13 years) please complete our Junior Surf Registration Form.

1. Personal details

Name *

First name

Last name

Date of Birth *

Address *

Address line 1

Address line 2

Address line 3

Address line 4

Town/Suburb

City

Postcode/Zip

Home phone

Mobile *

Email address *

Please advise us if your details change (including e-mail address)

1.1 Additional People

Name

First name

Last name

Date of Birth

Main Occupation

Mobile

Email address

+ Add another

2. Emergency Contact Details

Name

Contact Mobile

Relationship to Member

3. Membership Category Details

Please select a membership category below:-

3.1 Active Family

	Quantity	Price	Total
Active Family		$220.00	$

An Active Family Membership must have a patrolling, junior or qualifying member. Please enter the names of the Family Members:

3.2 Patrolling Member

	Quantity	Price	Total
Patrolling Member		$10.00	$

	Quantity	Price	Total
Surf Life Guard Award Qualification Fee		$60.00	$

3.3 Patrolling & Competing Member

	Quantity	Price	Total
Coaching Fee - Seniors (14-29 years)		$300.00	$

	Quantity	Price	Total
Patrolling Member		$10.00	$

	Quantity	Price	Total
Surf Life Guard Award Qualification Fee		$60.00	$

Please note:-

1. If joining as a patrolling or competing member you must hold your surf lifeguard award

2. To compete for the club as a senior, you must be a patrolling member

3. We have boards and skis available for hire - please contact us if you would like a board or ski

3.4 Associate Memberships (non-active)

	Quantity	Price	Total
Associate Member (1 person)		$170.00	$

	Quantity	Price	Total
Associate Family		$210.00	$

3.5 Gym only Membership

	Quantity	Price	Total
12 Month Gym Membership Fee		$320.00	$

	Quantity	Price	Total
6 Month Gym Membership Fee		$220.00	$

Total amount

Payment method *

If paying by Direct Credit, please note your name in the reference.

Credit Card

Direct Credit
Make deposit to account
02-0372-0164102-00

4. Surf Lifesaving New Zealand

Each member must be registered with Surf Life Saving NZ. It is free to register at:-

SURF LIFESAVING NZ

SLSNZ ID # (If known)

Do you hold any Surf Lifesaving New Zealand awards?

If YES, what award/s

Have you ever belonged to any other Sure Lifesaving Club?

If YES, which Club/s & when

5. Declaration

Mount Maunganui Lifeguard Service

Membership Application and Declaration

I, the undersigned apply for membership of the Mount Maunganui Lifeguard Service. In so applying and in consideration of my application for membership being accepted by the Board of Directors I acknowledge and agree that:
1. “Mount Maunganui Lifeguard Service” for the purposes of this declaration means and includes Mount Maunganui Lifeguard Service and its Directors, officers, members, servants or agents.
2. If accepted I will be a member of the Mount Maunganui Lifeguard Service and Surf Lifesaving New Zealand.
3. This document cannot be amended. If I do amend it my application will be null & void and cannot be accepted by Mount Maunganui Lifeguard Service.
4. I will be bound by the Mount Maunganui Lifeguard Service Constitution and any Regulations, Policies and Rules made under it. (Copies of the Constitution, Regulations and Policies are available on request from the Mount Maunganui Lifeguard Service office).
5. I have provided the information required overleaf and signed this form.
6. I give permission for my name to be entered onto the database and for Club information to be distributed to me.
7. I have read, understood, acknowledge and agree to the above declaration. I acknowledge that if my application for membership is successful I will be entitled to all benefits, advantages, privileges, services and obligations of Mount Maunganui Lifeguard Service membership.

Tick box to acknowledge the above declaration

Where an applicant is under 18 years of age this form must also be signed by the applicant’s parent or legal guardian.

Parent name

I am the parent or guardian of the applicant. I agree to be responsible for the applicant’s behaviour and agree to personally accept the conditions set out in this membership application and declaration.

Tick box to accept parents responsibility of the above declaration