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) *
Required
Services Provided *
Required
Disability *
Required
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
Clear selection
Your Full Name *
Your Job Title *
Your Phone Number *
Your Email Address *
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 *
Submit
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