MEMBERSHIP

First Name (required)

Last Name (required)

Address (required)

Address (required)

City (required)

Post Code (required)

Email (required)

Phone

Mobile

Date of Birth

Gender
MaleFemaleOther

Emergency Contact Name (required)

Emergency Contact Phone (required)




Physical Impairment (required)

Medical conditions we need to know about (required)

What Sports do you enjoy?




Voluntary Donation:
• Cheque payable to Parafed Taranaki, Parafed Taranaki, PO Box 5015, Westtown, New Plymouth
• Direct payment via internet banking, Bank account number: 15-3942-0010695-26. Reference you deposit ‘membership’ with your name.



Disclaimer:
Dear Member, Parent/Guardian, In order to promote the core work of Parafed Taranaki, we often photograph those attending events associated with Parafed Taranaki. The profiles can be online, in print and used in social media, as well as public relations material and video footage. All material collected is used specifically to enhance the work of Parafed Taranaki. Images and content may also be supplied to external news media to further achieve this goal. It is important for our ongoing success that we continue to develop this material. We would appreciate if you could sign the consent form below enabling us to appearing in our print, online and video material and in external news media. Please also sign below if you are happy that we, and any other party we contact, use images or video footage taken during events associated with Parafed Taranaki that may include you. If you are under 18, we need your parents or guardians permission.
I do give permissionI don’t give permission



I agree to be bound by the rules and regulations of ParaFed Taranaki
I do give permissionI don’t give permission