Child Poverty Action Group Inc.

PO Box 56 11, Wellesley St,

Auckland, 1141

New Zealand

(09) 303 9260

Membership Application/Renewal

Please fill out the information below and either email or post your completed form to the address above. If any of your details change, please let us know so that we can amend our database to ensure you are kept up-to-date.

Our guiding principle is the right of every child in New Zealand

to food, shelter, education and healthcare.

PERSONAL DETAILS
First Name
Last Name
Address
Suburb
City
Postcode
Phone 1
Email 1
Email 2
Organisation
Position
Date of Birth
Ethnicity
BRANCH
Please mark the centre nearest to you
Whangarei / Wellington
Auckland / Christchurch
None of these options apply to me
SUBSCRIBE VIA
Please mark one of the following options
Email (saves us money!)
Post
MAILING LISTS
Please mark which mailing lists you would like to join
Newsletters & Invitations
Press Releases
Reports & Submissions
Younger Person’s Group
Volunteers’ list
I AM INTERESTED IN
THESE ASPECTS OF CHILD POVERTY
Please mark as many as you wish
Health / Welfare Reform
Housing / Human Rights
Education / Activism/Advocacy
Household Income/Cost of Living
Other - please specify:
MEMBERSHIP FEES
Please mark which option/s applies to you
Individual (waged) / $20
Individual (unwaged) / $10
Organization / $100
DONATION (TAX DEDUCTIBLE) / $
TOTAL
  • Membership runs on a rolling year basis –e.g. if you join in Oct 2012, your membership is due for renewel in Oct 2013.
  • Membership subscriptions are not classed as ‘donations’ and therefore are not eligible for tax rebates.

JOIN US WITH A REGULAR CONTRIBUTION
Frequency / Weekly:_ / Monthly:_
Fortnightly:_ / Quarterly:_
Amount / $5:_ / $10:_
$100:_ / $20:_
Other:
$50:0_
  • Membership is automatic as long as your regular payments continue

PAYMENT OPTIONS
Direct Debit
Kiwibank 38-9003-0066858-00. Please use your name and ‘MEMB’ or ‘REGDON’ as a reference
Cheque
Please make out to Child Poverty Action Group Inc
Amount: / Payment Date:
Paid By:

Our guiding principle is the right of every child in New Zealand

to food, shelter, education and healthcare.

Thank you for your application, Child poverty Action deeply values and appreciates your support.

Our vision is of a New Zealand where no child has to live in poverty –

thank you for sharing that vision.

Our guiding principle is the right of every child in New Zealand

to food, shelter, education and healthcare.

Our guiding principle is the right of every child in New Zealand

to food, shelter, education and healthcare.