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I/we

Member Name

First Name

Last Name

Date of Birth

YYYY

Second Member Name (if applicable)

First Name

Last Name

Date of Birth, Second Member (if applicable)

YYYY

hereby apply to become a member/members of the West Waikato Coastal Community Catchment Group Incorporated Society. I am aware of the objectives of this group and the current annual fee of $20 per person to be an annual member. Children under the age of 18 can be members under your membership at no annual membership fee. I domicile in the management area of the society defined as being the West Waikato catchment area that flows into the Tasman Sea and the wider community who identify as being part of the West Waikato Coastal Community being the area south of Port Waikato and north of the Whaingaroa Harbour encompassing Ngati Tahinga iwi and hapu of Tainui.

Contact Details

Child Member Name (if applicable)

For children aged under 18 years old

First Name

Last Name

Date of Birth, Child Member (if applicable)

YYYY

Second Child Member Name (if applicable)

For children aged under 18 years old

First Name

Last Name

Date of Birth, Second Child Member (if applicable)

YYYY

Home Address

Email, for contact as a member

Phone

(###)

###

####

Emergency Contact Name

First Name

Last Name

Emergency Contact Phone

(###)

###

####

Message

Please supply extra details here if applicable

How did you hear about us?

Declarations

By submitting this form, I declare that: • The information provided above is true and correct • I agree to abide by the rules of the West Coast Coastal Community Catchment Group Inc. I understand that I can view these rules on the incorporated society website by completing a public search for the society or I can request a copy of the rules to be forwarded to me by the secretary

Application Date

YYYY

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Environment

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Apply here.

Get in touch

EXPLORE

What’s On

HealthyEnvironment

HealthyCommunity

Healthy
Environment

Healthy
Community