Affiliate Membership Form

AFFILIATE ATHLETE 2016/17

To confirm your Affiliate Membership to Blind Sport New Zealand for the year 2016/17 (1 July 2016 to 30 June 2017), please complete ALL applicable fields of the below Membership Form, and return to Blind Sport New Zealand with your 2016/17 Affiliation Fee (NZD$20.00).

Affiliation Fee should be deposited via Electronic Funds Transfer to:

Blind Sport New Zealand Incorporated

WESTPAC

03-0195-0325293-00

Reference SURNAME, AFEE

 

MEMBERSHIP FORM

Are you a member of a BSNZ Affiliated Sport? [radio* member use_label_element default:1 "Yes" "No"]

DECLARATION

 I declare that the above information is true and correct, and that any false information supplied will result in my being removed as an affiliated athlete of Blind Sport New Zealand Incorporated, and any funding received paid back to Blind Sport New Zealand Incorporated immediately.

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ABOUT US


Blind Sport New Zealand is the lead organisation for blind and low vision sport and recreation in New Zealand, charged with leading the growth of blind and low vision sport and recreation opportunity and increasing participation.

 

CONTACT


  • EMAIL:
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  • MOBILE:
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  • SOCIAL MEDIA:
  • dan@blindsport.kiwi
  • +64 9 9301579
  • +64 21 410384
  • Private Bage 99941 Newmarket, Auckland, New Zealand
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