Arthritis New Zealand Advocacy Registration Form
Would you like to become more closely involved with Arthritis New Zealand? Then register to become an advocate by completing the below form.
Email address
Arthritis New Zealand - Improving the lives of people affected by Arthritis
Full name
Your answer
Address including postcode
Your answer
Telephone (incl. area code)
Your answer
Electorate area (if known)
Your answer
DOB
MM
/
DD
/
YYYY
Ethnicity
Diagnosis
Your answer
Income
Would you be willing to speak to the media about your experience with Arthritis?
What's your area of interest for advocacy?
(tick all that apply)
Required
Please tell us about yourself, how Arthritis has impacted your life and what you would like to achieve as an Arthritis advocate.
1-2 paragraphs maximum
Your answer
Do you give us permission to add you to our mailing list?
A copy of your responses will be emailed to the address you provided.
Please complete the captcha before submitting the form.
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