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Type of Membership you are applying for:
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Associate Corporate |
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Hauora Name:
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Legal Status:
Inc Society, Trust, Company etc
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| Physical Address: |
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| Postal Address: |
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Phone:
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| Fax: |
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Email:
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| Web Site: |
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| Contact Person: |
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| Position: |
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| Phone: |
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| Email: |
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| Mobile: |
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Provider Type:
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Iwi, hapu, whanau based
By Maori for Maori
Maori unit within a non-Maori organisation |
Service Area:
Your geographical area |
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Services you provide:
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Hauora Profile
We have a section of our website dedicated
to promoting our HauoraProvider Members-
Please include below a brief profile on your
organisation and if possible include a photo
of your team etc for us to upload- a great
way to have an Internet presence if you
haven’t got a website. If you have, feel free
to mention your site address in your profile
so people can link to it. |
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Fee Payment (April- March each year)
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Associate Member Fee:
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$100.00 |
Corporate Member Fee:
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$150.00 |
Total amount enclosed:
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Cheque / Cash $ |
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Print this form before submitting and send a copy with your cheque payable to:
Nga Ngaru Hauora O Aotearoa
and mail to:
P.O Box 11269, Papamoa, Bay of Plenty
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SIGNED: ……………………………………………………………
DATE:………………...
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