Membership Application Form

First name/s*

Last name*

Address*

Phone

Mobile phone*

Email

I agree to pay my subscription annually (July) by cash at the KADAP office or by online banking.

Do you own your own home?*

Yes

No

Are there dogs on the property?*

Yes

No

We have: (tick all that apply)

Working fireplace

HRV/DVS

Heat pump

Smoke alarms

Would you like to receive your newsletter by

Email

Letterbox

Emergency contact name and phone number

I accept that KADAP will store my personal information in accordance with The Privacy Act 1993. Signed:*

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