Individual
$40.00
Family (2 Adults plus children)
$60.00
Dual (2 Adults)
Student
$30.00
Senior Citizen
Preferred Title: Title Mr Miss Mrs Ms Dr Sir Dame
Full Name:
Address:
Email:
Home Phone
Work Phone
Mobile Phone
Select Card Type:
MasterCard Visa
Name of Card Holder:
Card Number:
Expiry Date:
Month 1 2 3 4 5 6 7 8 9 10 11 12
Year (YY):
NOTE: This Information will not be encrypted
*Credit card payment online or fax/post to The Foundations Club, PO Box 893, Wellington, fax 04 496 1949
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