Membership Application Form

Application type

Registration

New Member Renewal

Membership number

Membership type

Personal information — Applicant

First name

Last name

Date of birth

Village

Home phone

Mobile phone

Work phone

Occupation

Email address

Personal information — Spouse (optional)

First name

Last name

Date of birth

Village

Home phone

Mobile phone

Work phone

Occupation

Email address

Address

House / street

Suburb

City

Post code

P.O. Box (optional)

Number

Suburb

City

Post code

Verification Documents

ID Document (Passport, Driver License, etc.)

Proof of Address (Utility bill, Bank statement)

Children (optional)

Name	Email	Date of birth

Interests

Select every area you would like to hear about.

Health / Fitness Youth Activities Social Room Activities Mandir Activities Business Forum Senior Citizen Activities

Communication preferences

Email Address P.O. Box

Volunteer Service: Please tick if you would like to participate in volunteer services Privacy: Please tick if you DO NOT want to publish your details on AIAI Publication e.g. Directory, Newsletter

Annual membership fee (GST inclusive)

Married Couple - $50 Senior Couple (Both 65+) - $25 Student - $20 Senior Single - $20 Single working member - $35

Subscription membership year is from 1st Jan to 31st Dec.

Direct Debit Account Number: 12 3109 0015103 00. Please quote your 'Membership Number' as reference. Email the completed membership form to office@aiai.org.nz.

Annual membership / donation ($)

Paid for year ($)

Paid by

Application date

Date paid

Signatures

Signature (Applicant)

Signature (Spouse)

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* Required fields.