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 *

Date of Birth

Membership Type *

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

Membership 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
$

Recurring period

This information is for people making recurring payments to ANZMES

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.

Total amount

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

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