NEW ZEALAND ROCKETRY
ASSOCIATION
Membership Application Form

 

Name
Title
Organization
Street address
Suburb
City
State/Province
Postal code
Country
Work Phone
Home Phone
FAX
E-mail
Web URL

Please select your membership category. Junior members must enter date of birth.

Adult (16 and over) - $NZ 45
Junior (under16)- $NZ 25
 
 

Date Of Birth

Additional Junior Family Member - $NZ 20
 
 

Name Date Of Birth

Please select your method of payment:

Cheque (Send your cheque to the Box No. below)
VISA or MASTERCARD only
Bill Payment (phone 64 9 846 5945 day to obtain account details)
 

Card No:
Expiry Date:
Name on Card:

If you prefer to fax your card details, fax them to: 09 624 2165



NZRA Box 13 368 Onehunga Auckland New Zealand Ph: 64 9 836 1592 Fax: 64 9 624 2165
Last revised: May 02, 2003
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