Mangawhai Domain Society Membership Application
This form provides a mechanism whereby persons permanently residing in the Mangawhai District and adjoining districts and in accordance with New Zealand's legal voting age, can apply for membership to the Mangawhai Domain Society. All such registrations will be received by the Secretary of the Mangawhai Domain Society Committee and considered at a subsequent regular meeting of the Committee. Proof of your Mangawhai District Address may be requested. If you have any questions on registration or would like to apply in writing please email the Secretary at or write to the Mangawhai Domain Society Secretary, PO Box 118 Mangawhai 0540. You can also apply online by going to
To the Secretary:
(All fields must be filled in)
Surname *
Your answer
First Name *
Your answer
Date of Birth *
Mangawhai District Address *
Your answer
Postal Address (if different from above)
Your answer
Phone Number *
Your answer
Email Address *
Your answer
Domain Society Subscription - from 1st April to 31st March
This is an annual subscription fee (currently $5.00) that can be paid by cash or cheque payable to Mangawhai Domain Society and post to PO Box 118 Mangawhai 0540, or by way of internet banking to Mangawhai Domain Society, ASB 12-3094-0155962-51 NB: Fee is subject to review annually at the AGM.
Subscription Paid *
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