Membership Form - The Boxer Club Inc.
01 June 2010 – 31 May 2011

Name:__________________________________________________

Address:________________________________________________

________________________________________________________

Phone:__________________________________________________

Mobile:__________________________________________________

Email Address:___________________________________________

Total to be paid: $_________________________________________

Please note all applicants are subject to confirmation by the committee of The Boxer Club Inc. Please send this application with the appropriate fee to the Secretary at the below address.

The Boxer Club Inc. - Secretary
16 Lothian Brae, Mahia Park, Wattle Downs, Manurewa 2102

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