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 for 2019 are:

..... $50 for an individual member

..... $75 for a couple living at the same address

..... $30 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.

MAIN APPLICANT

Name *

First Name Last Name

Address *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Phone Number *

- Area Code Phone Number

Email Address *

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

Qualify as a Junior Member? *

Yes No

Member of PSNZ? *

Yes No

Member of Another Photographic Club or Society? *

Yes No

Name of Club or Society *

Self-Assessment of Current Level *

Advanced, or A Grade Intermediate, or B Grade Novice, or C Grade

Areas of Interest: *

Digital photography Analogue (film) photography Landscapes Still Life Street Photography Photojournalism Portraits

How did you find out about KCPS?

SECOND APPLICANT - IF ANY

Is there a second applicant from the same address? *

Yes No

Name *

First Name Last Name

Email Address *

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

Member of PSNZ? *

Yes No

Member of Another Photographic Club or Society? *

Yes No

Name of Club or Society *

Self-Assessment of Current Level *

Advanced, or A Grade Intermediate, or B Grade Novice, or C Grade

Areas of Interest: *

Digital photography Analogue (film) photography Landscapes Still Life Street Photography Photojournalism Portraits

Please add any comments