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.
Regions Covered (If NZ-wide, please select all)
Waikato/Bay of Plenty
Lower North Island
Assessment & Coordination
Behaviour Support Services
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)
Level 1 – For organisations with revenue of $10 million or more
Level 2 – For organisations with revenue of $5 million to $10 million
Level 3 – For organisations with revenue of $3 million to $5 million
Level 4 – For organisations with revenue of $1.5 million to $3 million
Level 5 – For organisations with revenue of $1 million to $1.5 million
Level 6 – For organisations with revenue of $500,000 to $1 million
Level 7 – For organisations with revenue of up to $500,000
Level 8 – Associate Member: Organisation
Does your organisation produce an annual report? If yes, please email it to
Your Full Name
Your Job Title
Your Phone Number
Your Email Address
Date this form was completed
I Confirm that all the information provided is true and correct
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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