1 Year Membership Form

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Bays North Harbour 1 Year Membership Form

Contact Detials

* Indicates required field

Your Name *

First

Last

Gender *

Male Female

Date of Birth *

Ethnicity *

Occupation *

Mobile *

Email *

Partner's Name *

First

Last

Partner's Gender *

Male Female

Partner's Date of Birth *

Partner's Ethnicity *

Partner's Occupation *

Partner's Email *

*Please select an email address that will be accessible during any maternity leave.

Address

Address *

Street Address, Suburb, City, Post Code

Postal Address *

*If your postal address is differnt.

Membership

1 Year Membership - $95

More information on membership here.

Payment

Payment Options *

Payment information will be displayed on the next page after submitting your membership form.

How did you hear about Parents Centre? *

Lead Maternity Carer/Dr Friend/Family Facebook Internet (Google) Advertising (Print, Email, etc) Other

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

Yes No

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. *

e.g - 1 month, 3 months, 6 months

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.

Submit

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Parents Centre Aotearoa

Contact Us
Bays North Harbour Parents Centre
PO Box 300-135 Albany, Auckland 0752

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