SeniorNet Hutt City Inc. Membership Application Form
Complete and send this form, and arrange payment of the initial subscription fee.
You need a valid email address to apply on line.
Our New Member Co-ordinator will contact you in due course to discuss how SeniorNet may best meet your learning needs.
Section 1 - You
Are You A Previous Member of SeniorNet Hutt City Inc.
Information used for our database updates.
Is this application for you alone, or part of a joint application?
This application is for me alone (Subscription rate $25 per annum)
This application is part of a joint application where my spouse is also joining at this time (Combined subscription $40 per annum)
This application is part of a joint application where my spouse is already a member. (Combined subscription rate $40 per annum)
This information is required ONLY in the event you are submitting a joint application. Otherwise, leave it blank.
Your first name
Your family name
Street, suburb and city
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Your landline or mobile phone number
Enter numbers only. No spaces or other characters please.
Your email address
We will email you a confirming copy of your application.
Your Date of Birth
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