Annual Membership Form  ( for year ending 31/03/07 )         

Full Name:

____________________________________

 Postal address:

____________________________________

____________________________________

____________________________________

Do you wish to receive our monthly Marine Fishing & Hunting Newsletter By Email?    Yes  /    No    

 E-mail address:      ____________________________________(please print clearly)    Phone (daytime)_________________

        (after hours)___________________

 Main Outdoor Interest:  _______________________________________

Please tick Age Group:  18 to30 c    31 to 40 c     41 to 50 c     51to60 c        60 plus c

I would like to be considered as a List Candidate                   c

I would like to help with local committees/working groups c

How did you hear about us ? _______________________________________________

 Annual Membership fee $10

 Renew my membership     $10 to 31/03/2007                       c       

(Tick whichever applies)

 New membership          $10 to 31/03/2007                  c

The running of your Party is reliant on the voluntary contribution of time and effort freely given by your Party administration.

To meet the costs of mounting an effective campaign however, the financial assistance of members and supporters is essential.  All donations therefore are greatly appreciated and put to good use in furthering your cause.

My Donation of  c$10   c$20    c$40   c$50   c$100       c Other $___________ Is included  ( tick box)

I would like to make regular donations

by Automatic Payment                                                          c   ( we will send you the required form)

Tick this box if you require a receipt……                    c

Payment methods accepted -Cheque/Cash   

Amount enclosed $_____________________

Signature…………………………………….. Date…………………………..

Please complete this form and post (with your payment) to: Outdoor Recreation NZ, P.O.Box 36381, Northcote, Auckland