Application for Membership of Blind Citizens NZ

This form is for people to apply for membership of Blind Citizens NZ.

On receiving your Application, we will contact you to arrange your payment for your chosen membership subscription.

Fields marked with an asterisk (*) are mandatory.

Choose the title that is appropriate for your name.

Enter your first name or names

Enter your surname or family name

Enter the first line of your address

Optionally enter the second line of your address, but this is not for the suburb or city which you will enter next.

Optionally enter your suburb. This is not for your town or city which you can enter next.

Enter your town or city.

Enter your postcode if you know it. You can visit the New Zealand Post Postcode directory if you would like to look up your postcode.

Enter your phone number including area code.

Optionally enter your date of birth

Choose the format that best suits you to receive information from us.

Optionally enter your email address

Are you a member of the Royal New Zealand Foundation of the Blind or eligible to be a member?

Optionally enter your RNZFB member number

Are you currently in full-time or part-time employment?

Choose the type of membership of the Association you want

$

This amount is due when your application for membership is approved