ADHD.co.nz

Become a Member

To become a member, either email us by filling out the form below, or click here to download a printable form.

	First name	Last name
PARENT or GUARDIAN

	Date of Birth	Male	Female
CHILD/REN

ADDRESS

	Home	Work	Mobile
PHONE/s

NEW MEMBERSHIP OR	$30.00	$
SUB-RENEWAL	$20.00	$
DONATION (Donations $5 and over are tax deductible)		$
OTHER		$
TOTAL AMOUNT		$

RECEIPT REQUIRED?	YES NO

METHODS OF PAYMENT

(1) CHEQUE Please make cheque out to: ADHD Association Inc.(cross out bearer, mark 'not transferable') and mail with the printable form to: P.O. Box 51-675, Pakuranga, Auckland, New Zealand

(2) DIRECT TO OUR BANK ACCOUNT

3056

0660474

Please put your name for identification on our bank statement, and submit this form.

When payment and form are received membership entitlements/product will be sent.

THANK YOU!