GST REG. No: 10-387-272

Please print then complete and mail or fax this form

APPLICATION FOR NEW NZTBA MEMBERSHIP

I/We wish to join the New Zealand Thoroughbred Breeders' Association and receive membership benefits including the NZ Stallion Register.

NAME(S) (in the case of a couple or partnership please include both names):

____________________________________________________________

____________________________________________________________

ADDRESS:___________________________________________________

____________________________________________________________

PH: ______________(work)___________(home) FAX:________________

EMAIL:_______________________________________________________

 ANNUAL MEMBERSHIP SUBSCRIPTION

NEW ZEALAND RESIDENTS	$NZ160.00 incl. GST
AUSTRALIAN RESIDENTS	$NZ200.00
OTHER OVERSEAS RESIDENTS	$NZ225.00 (overseas subscriptions include airmail postage but are exempt from GST)

Cheque Enclosed for: $NZ_____________________ or

Please charge my Credit Card: $NZ _____________

Please mail the completed form with your cheque, or fax with your credit card details to: New Zealand Thoroughbred Breeders' Association Private Bag 99908, Newmarket Auckland, NEW ZEALAND  Fax: (64 9) 525 2434

VISA / MASTERCARD (Please circle one)

Card No:______________________________

Expiry date:___________________________

Card Name:___________________________

Signature_____________________________