NZDSN Organisational Membership Application Form
This form allows you to apply for organisational membership with NZDSN.

Once we have reviewed the application, we will make contact with you to finalise the details.

The application information is forwarded to the NZDSN Board for final approval once all relevant information has been received.

This form allows you to complete the relevant information that you would like on the NZDSN website regarding your business or service.  Please note some of this information may be abridged and NZDSN has the right to withhold any information.  Should this be the case, we shall make direct contact with you.
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Untitled Title
Regions Covered (If NZ-wide, please select all) *
Required
Services Provided *
Required
Disability *
Required
Do you Receive Funding *
Name of Organisation *
Organisation Long Description (This will appear on our website) *
Organisation Contact Name (This will appear on our website) *
Organisation Contact Address (physical/postal), if it's multi-site, please note the head office (This will appear on our website) *
Organisation Contact Phone Number(s) (This will appear on our website) *
Organisation Contact Email (This will appear on our website) *
Organisation Website (This will appear on our website) *
Membership Options *
Does your organisation produce an annual report? If yes, please email it to admin@nzdsn.org.nz *
*
CE/Manager Name (for NZDSN use only) *
Job Title (for NZDSN use only) *
CE/Manager Phone Number (for NZDSN use only) *
CE/Manager Email Address (for NZDSN use only) *
Date this form was completed *
MM
/
DD
/
YYYY
I Confirm that all the information provided is true and correct *
Required
I Understand I am giving permission for the information provided in questions 1-10 to be placed on the NZDSN website *
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