Membership Form

Your name *

First

Last

Gender *

Male Female

Date of Birth *

Ethnicity *

Occupation *

Partner's Name: *

First

Last

Gender *

Male Female

Date of Birth *

Partner's Ethnicity *

Partner's Occupation *

Physical address

Street Address *

Suburb, City & Post Code *

Postal address (if different)

Postal address *

Suburb, City & Post Code *

Contact Phone number

Membership / Course Bookings

Membership / Course Type *

1 Year Membership, Antenatal, Baby & You, Moving & Munching ($295) 1 Year Membership, Antenatal, Baby & You ($270) 1 Year Membership, Baby & You ($110) 1 Year Membership ($80) Moving & Munching Course Other

Course Code or Dates (if applicable) *

If registering for the Antenatal (Child birth) Course:

Are there any special circumstances about you or your antenatal history that you would like us to be aware of? (Miscarriages, previous pregnancies, etc) This information will be strictly confidential to our Childbirth Education Team. *

Payment Options *

Bank Transfer: Bays North Harbour Parents Centre Inc, ASB Bank, 12-3136-0008486-00 PayPal (also includes debit & credit card payments) - PayPal button will appear after form is submitted

Please note, your membership will be activated about approx 2 weeks prior to the commencement of your course to ensure you can maximise our membership benefits when you have your child.

Cancellations for Antenatal Courses – A minimum of 28 days notice prior to the start of a course is required. Cancellations after this date will not be refunded. Cancellations prior to 28 days will incur a $25 administration fee. If you are no longer wishing to attend antenatal classes please contact us to advise.

How did you hear about Parents Centre? *

Are you interested in volunteering for Parents Centre now or in the future? *

Yes No

If interested, please indicate when you would like to be contacted. Eg. 1 month, 3 months, 6 months *

Do you wish to receive offers from carefully screened companies whose products or services we think you may be interested in? *

Yes No

This information will be used for the purpose of Parents Centre membership and courses and the compilation of national statistics. Individuals may view and correct information about themselves by contacting the membership officer for their Centre.

If you haven't heard back from us within a few days, please check your junk/spam email folder as our replies can sometimes end up in there in error.

Bays North Harbour Membership Form