Nga Uruora - Kapiti Project Membership Form
| CONTACT DETAILS: | |||
| New Member? | [ ] | Member Renewal? | [ ] |
| Last Name: | First Name: | ||
| Postal Address: | |||
| Town: | City: | ||
| Postal Code: | Phone: | ||
| Email: | |||
| MEMBERSHIP TYPE: | ||||
Student: |
[ ] |
$5.00 | ||
Low Income: |
[ ] |
$10.00 | ||
Regular: |
[ ] |
$20.00 | ||
Family/Household: |
[ ] |
$30.00 | ||
Financial Supporter*: |
[ ] |
$100.00 | ||
Donation**: |
[ ] |
$________ | ||
5 Year Membership: |
[ ] |
$50/$100/$150/$500 | ||
Life Membership: |
[ ] |
$500 | ||
| *You will be receipted for $30 membership sub and $70 donation, as per our policy. | ||||
| **We are a Charitable Trust. Donations $5.00 and over are tax-deductible. | ||||
| PLEASE SEND ME INFORMATION ON: | |||
| Volunteering at the Nurseries: | [ ] | Volunteering in the Hills: | [ ] |
| Volunteering on the Flat: | [ ] | Volunteering around Town: | [ ] |
| I can offer these skills, too: | |||
| Multiple Years Membership: | [ ] | Gift Membership: | [ ] |
| Business Sponsorship: | [ ] | Bequests: | [ ] |
| Automatic Payments: | [ ] | Just send the newsletter, thanks: | [ ] |
| Thank you very much for your support. You will receive our beautiful colour poster, requested information
receipt, and most recent newsletter with the next few days... Please make cheques out to: Nga Uruora - Kapiti Project, and post to: P.O. Box 1, Paekakariki, Kapiti Coast 5258 or Via internet banking. Details are: Bank: Westpac Account Name: Nga Uruora - Kapiti Project Account #: 03 0510 0772406 00 Reference: [your surname] Please note that you have paid via internet banking on your membership form, and send to the above address. Thank you! |