Vanuatu-Japan Friendship Members Club

 

Application for Membership

 

[please fill out by pen in capital letters; name should be as appearing in passport]

 

 

Family name:                ___________________________________

 

Given name(s):              ___________________________________

 

Nationality:                   ___________________________________

 

Passport number:                      ___________________________________

 

Permanent address:       ___________________________________

 

___________________________________

 

Mailing address:                        ___________________________________

(only if different)

___________________________________

 

Email address:              ___________________________________

 

Number of Memberships I am purchasing:                     _______

 

Membership Fee Payment Option:                    ___ single payment

(check one)                                          ___ two installments

                                                            ___ four installments

 

 

I hereby apply for membership in the Vanuatu-Japan Friendship Members Club.  I understand that the Club’s Charter sets out all legal rights and obligations of each member in relation to the Club and as against Vanuatu-Japan Friendship Corporation.  If this application is approved, I promise to abide by the Charter.

 

I declare that I am over the age of twenty years, am not presently declared bankrupt, and have never been convicted of a criminal offence in any country.

 

_______________________________

(signature)

 

Date:    ________________________

 

 

Name of Club member recommending this application: _________________________

 

_______________________________

(signature)