Application to Join SeniorNet West Auckland
SeniorNet West Auckland Inc
ONLINE PAYMENT: Log on to your bank and go to one off payments. Copy the following account number 12-3100-0154721-00 into the payee field.
MOST IMPORTANT: Enter "Join" in the first reference field. Enter your first name in the next field & surname in the third space
Annual Subscription: 1st January to 31st December.
Suburb & Postal Code
Landline phone number
Mobile phone number
Contact name & phone number of person to contact in an emergency
For funding purposes we need to know your gender, age, ethnic groupings & residency status.
Please tick boxes as applicable:
50 to 59
Non Nz resident
Joining / Subscription Fee
I have paid online
I am paying by cheque
What operating system are you using
HTML Contact Form