New Member Subscription Form Organisation Details

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Section 1. Organisation Information

Email *

What is the Name of the Organisation *

What type of Organisation are you? *

(Please note: If your organisation is not a Community Group or NGO, your membership will be considered under the "Associate Member" classification, this will entitle you to all our publications and meetings, however you will not have voting rights under our constitution.

Registered Charity

Community Based Organisation

Co-Operative Liability Company

Government Department/Agency

Private Business

Limited Liability Company

Other

Contact Name *

Contact Person for Administration

Are You Wellington Based? *

Yes

We are not based in Wellington but have a Branch there

Main Office Postal Address *

This address will be used for all postal communications including Newsletter and Subscription invoicing

Main Office Email Contact Address *

Administration email contact

Main Office Phone Number *

Main Office Physical Address *

Do You Provide Services From This Address? (If Yes Please mark the services you provide in the tick box below)

Yes

Clear selection

What Services Do You Provide from your Main Office?

Community Venues and Op Shops (i.e. Churches, Community Centres, Affordable Venue Hire and Op Shops)

Mental Health / Addiction and Violence Prevention (i.e. Gambling, Drug and Alcohol Addiction, Rape Crisis, and Counselling Services)

Wrap Around Services and Welfare (i.e. Provides Full Support Shelter, Food, Life Skill Training, Counselling)

Legal Support, Employment and Budgeting (i.e. Free Legal Advice, Dress For Success, C.V. writing, Budgeting, Volunteering)

Food Security Services ( i.e. Food Rescue, Soup Kitchens, Food Banks)

Community Training and Education (Training Orgs)

Physical Health Services (i.e. Diabetes, Hearing, Blind, Low Cost Health Centres, Family Planning, Dental Services)

Advice, Support and Advocacy for a Specific Group (i.e. Pacifica, Maori, LGBTQIA, Refugees, Women, Children, Men, Disabilities ….. )

Housing and Accommodation (i.e. Emergency Accommodation, Night Shelter)

What Groups Do You Provide Services To?

Children

Youth

Older Persons

Women

Men

Families

People with Disabilities

LGBTQIA

Maori

Pasifika

Specific Ethnic Group

Former Refugees

All Sectors (No Specific Target Group)

Do you provide services from other locations? *

Yes

If Yes please add other locations you provide your service. (If the service differs from your core service, please put the corresponding service number beside each address, see list of services below) i.e. Newtown CAB, 100 Smith Street, Newtown - 4,7,9

This information is required for the Wellington Region community mapping. (There is extra space below to add more branches if required)

List of Services and Corresponding Numbers

Add more locations for your service

Add comments about your satellite services here?

Are you happy for us to promote your organisation on our website and include you in the Community Mapping? *

You can opt out of this at any time, by emailing our office - office@cnw.org.nz

Yes

If Yes please let us know your organisations website address

Is your organisation membership based? *

Yes

If Yes how many members do you have?

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