Membership Form

What is the reason you are using this form?

New ApplicationRenew Membership

1) Enter your name, email address, and phone number
2) Choose membership category
3) Use internet banking to pay your membership fee
4) Submit this form.

Your Name - first and last (required)

Street Address, Suburb and City

Your Email (required) Privacy Policy

Your phone number (required)

I have read, understood and agree with the Rules of Incorporation

Membership Level:
Individual $10Family $20Business $20

If you would like to make a donation, you can add that to your membership fee or make a separate payment.

Internet Banking

We are no longer able to accept cheques, please use Internet Banking / Cash Deposit: to: Kiwi Bank: 38 9005 0299006 00

PLEASE ensure that you include your surname and phone number as the Reference: - the same name and phone number entered above.

Receipts

We no longer issue receipts for internet payments, due to the increasing costs to do so. However, if you require a receipt please click the box >>>Please send me a receipt.

Message

Please let us know if you have anything you’d like to help with in regards to the Birkenhead Resident’s Association.
(General correspondence should be sent via our Contact Form)

Your Message