Membership Form

Contact details

Please provide us the following information:

Our organisation is a community organisation which is:

We provide the following services:

Our organisation is:

We wish to apply for membership under category:

Are you a registered charity or do you have IRD approval for charitable tax status?

Based on your total annual expenditure, please select your membership fee level from the scale below (GST included).

Please post the following to us at PO Box 9517, Wellington 6141, once you have submitted this online application:

• A copy of your Rules or Constitution
• Your most recent Annual Report, including your most recent financial statements
• A cheque for the correct amount of your membership fee you selected above
  (or pay us direct via Internet banking to 02 0568 0321691 00 and provide your organisation's details as clearly as possible).
• List of your member groups and addresses (if a national organisation)

Please provide full names of 2 officers authorising this application: