Loading
ANZMES Membership Form
- Full subscription cost is $10.00.
- Family subscription cost is $5.00 for each additional family member.
- Reduced subscription cost is $5.00. This is available for those who have financial constraints.
Please note: all personal details will be kept strictly confidential.
Persons name
*
Title
First name
Last name
Persons address
*
Address line 1
Address line 2
Address line 3
Address line 4
Town/Suburb
City
Postcode/Zip
Email address
Telephone number
Date Joined
Gender Identity
*
Female
Male
Not Recorded
Transgender
Date of Birth
Membership Type
*
Complimentary
Family Member
Full membership
Helping Hands
Honorary Life Membership
Life Time Member
New Member
Overseas Member
Reciprocal
Reduced
Membership number (if renewing membership)
Meeting Place distribution options
*
Meeting Place magazine distribution via Email
Meeting Place magazine distribution via Post
No Meeting Place magazine needed
Additional Family member (only complete if applying for family membership)
First name
Last name
Email address of Additional Family Member
+ Add another
- Remove
Membership Amount
*
$10.00 Single Membership
$15.00 One Extra Family Membership with Single Membership
$5.00 Helping Hands Membership
Other amount
$
$10.00 Single Membership
$15.00 One Extra Family Membership with Single Membership
$5.00 Helping Hands Membership
Other
$
Donation Amount
Note: Your donation is fully tax deductible.
No Donation $0.00
$10.00
$20.00
$50.00
$100.00
Other amount
$
No Donation $0.00
$10.00
$20.00
$50.00
$100.00
Other
$
Recurring period
This information is for people making recurring payments to ANZMES
One time
Weekly
Every 2 weeks
Once per month
4 Weekly
3 Monthly
6 Monthly
Annually
First payment date
This information is for people making recurring payments to ANZMES
Last payment date
This information is for people making recurring payments to ANZMES
Please let us know if you have a particular area that you would like your donation to go towards.
Payment method
*
If paying by cash please attach contact details and send to ANZMES, 43 Princes Street, Dunedin Central, Dunedin 9016.
If paying by direct transfer to ANZMES Bank account -
01 - 0414 - 0276330 - 00
Stripe - Credit & Debit Cards
Cash Payment
If making a cash payment, please send to -
ANZMES,
43 Princes Street, Dunedin Central, Dunedin, 9016
Direct Transfer to Bank Account
Internet Bank Payment
Pay processing fee
We are charged a small fee for processing online payments.
$
Total amount
$
Please check the highlighted fields
✔
✘