Please send form with cheque to : Mick Maher, 25a Haig Ave, Mt Roskill, Auckland,

Name : .......................

Address : .....................

Date of Birth : …………………… E-mail : …………………………………...

Telephone : : Res…………………… Bus : ………………… Mobile :…………….

Please indicate if you have any objection to your name, address and phone number being circulated to other members.

Pass on / Do not pass on my details to other members of the club.

Signed : ………………………………

Date : ……………………..

Conditions :

I understand that membership will entitle me to monthly Newsletters, 24hr Hotline and access to videotapes of Glasgow Celtic games, to be viewed on a regular screening nights. (additional fee's will be necessary for private viewing)

In becoming a member of the NZCSC, I confirm that I will not harm the reputation of Celtic Football Club and the NZCSC. I will abide by the NZCSC constitution and rules.

I understand that membership fees will be for the period to/including 31st July 2005.

I will not give out the NZCSC hotline telephone number to non members.

Membership Fee's :

August 2004 - End July 2005 $40

Cheques to made out to: NZ Celtic Supporters Club.