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New Member Subscription Form Individual Details
Section 1. Who you are?
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* Indicates required question
Email
*
Your email
What is your Name?
*
Your answer
Are You Based in Wellington?
*
Yes
No
How would you like to receive our newsletters?
*
Email Only
Hardcopy
Both Email and Hardcopy
Postal Address
*
This address will be used for Subscription invoicing and Monthly Newsletters
Your answer
Email Contact Address
*
For Publications
Your answer
Contact Phone Number
*
Your answer
Are you affiliated with a Wellington Community Group ?
*
Yes
No
What is the Name of the Group
Your answer
Do you have a special interest in a specific sector of the community?
If yes please state below
Your answer
Comments
If you have any other comments please add below
Your answer
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