HAAI Membership Form

Membership Auckland

Given Name

Family Name

Date of Birth

Gender

Marital Status

Dependent Children

Phone/Mobile

Home Address

Partner details

Please provide your partner's details below.

Given Name(s)

Family Name

Date of Birth

Phone/Mobile

Dependent child(ren) details

Please provide the details of your dependent child(ren). Dependent child(ren) mean any child 18 or under living with you. You can more children by clicking (+) button

Full Name	Date of Birth	Occupation	Field of study/Employment?

Membership Fee

$11.00

Membership Fee

$6.00

I agree to pay a membership fee (stated above) every month. When you click Submit Form button you will be redirected to payment page where you can enter your card. The card will be automatically charged every month and a receipt will be emailed to you.