Caversham Harrier & Athletic Club

• First Name:
• Surname:
• Date of Birth:

• Address 1:
• Address 2:
• Suburb:
• City:
• Post Code:
• Email Address:
• Phone Number:

• Social (Yet to be set for 2012/13 year)
• Registered (Yet to be set for 2012/13 year)
• Athletes aged 19 or under on 31 December 2012 will have free membership

Payment can be made direct to the Club's Bank Account 03-0903-0383903-00 at Westpac Bank Moray Place. Please enter your Surname in the reference field. Receipts will be forwarded for all Internet payments Or alternatively post your cheque to:

• The Treasurer
• Caversham Harrier & Athletic Club Inc
• P O Box 5378
• Dunedin 9058