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.





Date:    ________________________



Name of Club member recommending this application: _________________________