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Mutual Support Membership Application
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Have you read and accept the Club Rules and Bylaws?
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If No, please give us feedback in the Comment box at the bottom of this page and submit
Click here to see the Bylaws
Bylaws
If no, please provide the principal reason
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Salutation - (eg. Dr. Mr. Mrs. or Miss)
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Your profession/occupation:
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Your surname as on your ID document
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Your first or name/s as on your ID document
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Chosen name or nickname - what you like to be called
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Address with proof thereof
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Email
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Repeat e-mail address for verification.
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From the e-mail address above, e-mail a copy of your Identity Document, Proof of Residence and a full length photograph of yourself and others included in your membership for our membership directory.
Phone Number
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List at least two current members who would recommend you. (If you do not know any, say None)
Member #1
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Member #2
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If you don't know any members yet, please provide at least two other references, your relationship to them and their contact details:
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Reference #2
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List at least two others who you believe would make great members and their contact details:
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Recommedation #2
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Of which other clubs or organizations are you a member? Details and contact information.
Club or Organization #1
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Club or Organization #2
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Have you ever been charged with or convicted of a crime? If yes, provide details below.
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