Connect South Membership Form
Fees are:
$46.00 (inc. GST) for individuals
$57.50 (inc GST) for small organisations
$92.00 (inc. GST) for large or governmental organisations

You can pay on-line from the email you will receive after completing this form.

Or, hand-deliver cash payment with name and number to:

Connect South
Dunedin Community House
301 Moray Place, Dunedin 9016

Or, please post cheque payment with name and number to:

Connect South
PO Box 5222
Moray Place, Dunedin 9058

Future membership fees will be invoiced annually.

The information collected in this form is for administrative purposes and
may be used to send you/your organisation information on community
activities. You have the right to access and correct your information, subject
to the restrictions of the Privacy Act 1993.

Email address *
Email *
Your answer
Organisation name (if applicable)
Your answer
Your role or title (if applicable)
Your answer
First Name *
Your answer
Last Name *
Your answer
Phone *
Your answer
Fax
Your answer
Website
Your answer
Billing address *
Your answer
Brief description of your organisation
Your answer
How did you hear about Connect South membership?
Your answer
As a member you are eligible for a discounted insurance package - would you like a broker to get in touch with you about this?
Do you/does your organisation support the objectives of Connect South?
Connect South's constitution—and other information about our organisation—is available in hard copy at our office and electronically on our website www.connectsouth.org.nz.
I have the authority of my organisation to sign up for this membership.
A copy of your responses will be emailed to the address you provided.
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