National membership application

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Please complete this form with as much detail as possible.

Name *

Email - to receive newsletters & other correspondence

Address - used for newsletters if you don't give an email address *

Phone number *

Subscription

The national subscription is currently $10.00 a year or $100.00 for life membership. Please pay directly into our bank account at Kiwibank

Number: 38-9003-0932058-02

Name: NZ Cornish Association

Please use the Particulars Code and Reference fields in your bank payment instructions to identify yourself so that we can match your payment with your membership.

NZ Cornish is always grateful to receive donations.

Receipt *

Please e-mail a receipt

I don't need a receipt, thanks

Comments

Please use the space below to send us any further info such as an outline of your link to Cornwall or if this subscription is a gift for someone other than yourself or whether your payment includes a donation

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