The Monarchist League of New Zealand Inc.

APPLICATION FOR MEMBERSHIP

TITLE (Mr/Mrs//Miss/Dr/other) ......................................................................................................

CHRISTIAN OR FIRST NAMES (if applying for joint membership include names of family

members) .......................................................................................................................................

SURNAME ...................................................................................................................................

POST-NOMINAL LETTERS (if any) .............................................................................................

EMAIL ADDRESS ........................................................................................................................

POSTAL ADDRESS .....................................................................................................................

TELEPHONE NUMBER(Home) ....................................................................................................

(Work) ..........................................................................................................................................

OCCUPATION .............................................................................................................................

HOW DID YOU LEARN ABOUT THE LEAGUE? ........................................................................

RELEVANT INTERESTS .............................................................................................................

DATE OF BIRTH (only needed if applying for student membership) ...............................................

MEMBERSHIP CATEGORY

Subscription for the period 1 April 2008 to 31 March 2010 (Please indicate which membership category)

Individual NZ$30

Joint [members of same family resident at same address] NZ$35

Student [attending educational institution full-time, and under 25 years of age] NZ$15

Life membership is NZ$500

Overseas applicants please add $10 to each subscription (payment must be in New Zealand dollars)

Enclose a cheque made out to "The Monarchist League of New Zealand Inc

Signature ....................................................................... Date ........................................................

Please return completed application form and cheque to: The Membership Officer, The Monarchist League of New Zealand, c/- 7 Cotter Avenue, Remuera, Auckland 1050, New Zealand