Membership Application

Simply complete this form to become a member with Te Arahina – Maori Culture Community of Geelong Inc. Membership is free.

Membership Type*
Name*
First Last
Date of Birth*

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MM
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Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone*
Email
Number of Adults*
Adult 2 Name*
First Last
Adult 2 Date of Birth*

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MM
YYYY
Phone
Email
Number of Children*
Child 1 Name*
First Last
Child 1 Date of Birth*

DD
MM
YYYY
Child 2 Name*
First Last
Child 2 Date of Birth*

DD
MM
YYYY
Child 3 Name*
First Last
Child 3 Date of Birth*

DD
MM
YYYY
Child 4 Name*
First Last
Child 4 Date of Birth*

DD
MM
YYYY
Child 5 Name*
First Last
Child 5 Date of Birth*

DD
MM
YYYY
Child 6 Name*
First Last
Child 6 Date of Birth*

DD
MM
YYYY
Mema Whanau*
Price: $ 0.00
Mema Kura for 1 Adult & Children 17 and under*
Price: $ 0.00
Mema Kura for 2 Adults (Children 17 and under)*
Price: $ 0.00
Name of Ropu (Group/Organisation)*
If you have an ABN or INC number? Please enter it here.
Number of Members in Ropu
Please enter a value between 2 and 1000.
Ropu Address*
Street Address Address Line 2 Suburb State Postcode
Ropu Phone Number*
Ropu Email
Ropu Website
Ropu Contact Person: Name
First Last
Ropu Contact Person: Phone Number
Ropu Contact Person: Email