Membership Application Form

MEMBERSHIP APPLICATION FORM

Please fill out the following details for your membership application, then press Submit Form at the bottom.

You can pay your membership fee online using your name as a reference in the payment by direct credit to:

Bank Account Name: Kapiti Coast Photographic Society Inc.

Bank Account Number: 03-0732-0616548-00

or by bringing payment of cash or cheque to the next KCPS meeting.

Membership fees are:

..... $55 for an individual member

..... $85 for a couple living at the same address

..... $35 for a junior, under 19 at school, or under 25 and a full-time student

There is a discount of $5 for each applicant who is already a full member of PSNZ.

These fees apply to applications that are submitted either before July 1 or after October 31. In the former case the membership lasts until the end of the current year. In the latter case membership expires at the end of the following year.

Fees for membership applications between July 1 and October 31 are half the amounts above. The PSNZ discount remains at $5.

Some examples:

An individual who is also a member of PSNZ applying in May pays $50.

A couple applying in February for joint membership where one is a PSNZ member and the other is not will pay $80.

An individual who is not a PSNZ member applying in August will pay $27.50. Being a PSNZ member would bring that price down to $22.50.

MAIN APPLICANT

Name*

First NameLast Name

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Phone Number*

Area CodePhone Number

Email Address*

Confirmation EmailPlease enter your email so we can send an acknowledgement of your application and use it to contact you

Qualify as a Junior Member?*

YesNo

Member of PSNZ?*

YesNo

Member of Another Photographic Club or Society?*

YesNo

Name of Club or Society*

Self-Assessment of Current Level*

Advanced, or A GradeIntermediate, or B GradeNovice, or C Grade

Areas of Interest:*

How did you find out about KCPS?

By submitting this form you are agreeing to join KCPS as a Financial Member.

My email address may be made available to other Financial Members*

AgreeDisagree

My phone number may be made available to other Financial Members*

AgreeDisagree

My postal address may be made available to other Financial Members*

Agree full addressAgree town/suburb onlyDisagree

SECOND APPLICANT - IF ANY

Is there a second applicant from the same address?*

YesNo

Name*

First NameLast Name

Email Address*

Confirmation EmailPlease enter your email even if it is the same as the first applicant

Phone Number

Area CodePhone Number

Member of PSNZ?*

YesNo

Member of Another Photographic Club or Society?*

YesNo

Name of Club or Society*

Self-Assessment of Current Level*

Advanced, or A GradeIntermediate, or B GradeNovice, or C Grade

Areas of Interest:*

My email address may be made available to other Financial Members*

AgreeDisagree

My phone number may be made available to other Financial Members*

AgreeDisagree

Please add any comments