Mahi Tahi Tātou Charitable Trust
Annual Membership Form

Primary Member Details

Name(Required)

First Last

Address(Required)

Street Address Address Line 2 City Region Postcode Country

Phone

Date of Birth(Required)

Membership Fees

Membership(Required)

Individual - $20

Family/Whānau - $80

Business - $500

Please choose the appropriate membership above. We are more than happy for you to set up an automatic payment to pay off your membership in installments.

Additional Family/Whānau Members

Please list any family/whānau members that will be included in family/whānau membership

How many additional members for your family/whānau?

Name

Date of Birth

Address (if different)

Name

Date of Birth

Address (if different)

Name

Date of Birth

Address (if different)

Name

Date of Birth

Address (if different)

Optional Questions

You don't need to answer these questions but any information you supply may help us to gather statistics about our members or to apply for funding.

Do you identify as having a disability?

Yes

Do you identify with any of these?

Intellectual

Physical

Neurodiverse

Mental Health

Other

Please enter details

Interests

I/we are interested in

Information

Workshops/courses

Social activities/events

Employment

Selling work on commission

Volunteering

Other

Other interests

“Mā to rourou, mā tōku rourou, ka ora ai te iwi” By your contribution and my contribution, we will make progress.

Total Membership Fees Due

Payment Details

How would you like to pay?(Required)

Card Payment

Internet Banking

Credit Card

Card Details

Cardholder Name

Once you have filled in this form you will need to deposit your payment into our bank

Our bank account number is: 06-0689-0972191-00 and our account name is Mahi Tahi Tatou Charitable Trust

Please put your last name in the Particulars and put the type of membership in the Code, e.g. Individual, Family, Whanau, Business

We are more than happy for you to set up an automatic payment to pay off your membership in installments.

Name

This field is for validation purposes and should be left unchanged.

Join as a member and support our work

Mahi Tahi Tātou Charitable Trust
Annual Membership Form

Primary Member Details

Membership Fees

Additional Family/Whānau Members

Optional Questions

Interests

Payment Details

Once you have filled in this form you will need to deposit your payment into our bank

Become a Member

Become a Volunteer

“Mā to rourou, mā tōku rourou, ka ora ai te iwi”

Join as a member and support our work

Mahi Tahi Tātou Charitable Trust Annual Membership Form

Primary Member Details

Membership Fees

Additional Family/Whānau Members

Optional Questions

Interests

Payment Details

Once you have filled in this form you will need to deposit your payment into our bank

Become a Member

Become a Volunteer

“Mā to rourou, mā tōku rourou, ka ora ai te iwi”

Mahi Tahi Tātou Charitable Trust
Annual Membership Form