Please complete this form to become a member or supporter.
Your details will be kept confidential as required under the Privacy Act.
This information will help us when we are applying for funding for projects, we won't share your personal details with funding providers, but the overall statistics help us put together a good argument for funding. Your cooperation is appreciated!
Please choose type of membership, Individual Member, Family, or Supporter. *
First Name *
First Name if individual membership, if your'e joining as a family please type 'family' in here.
Family / Surname *
For both individual or family membership
Number of Family members
If you're joining up your family, help us by stating numbers of family members (there's no limit to how many you can have)
email address *
Mailing address 1: Number and Road. *
Mailing address 2: Suburb *
Mailing address 3: Post Code
Mailing Address 4: City *
Contact Phone Number
Please help us by sharing your interests *
Environmental Activities
Can you help with any of the following?
If you check these boxes we will contact you about further involvement.
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This form was created inside Muriwai Environment Action.