Historic Places Trust
Pouhere Taonga
- Membership Application
1. Please enter your personal details.
Title:
Mrs.
Ms.
Miss.
Dr.
Prof.
Mr.
Mr & Mrs.
Given Name(s):
Surname(s):
Mailing Address:
Telephone:
Email Address:
2. Select a Membership Category.
Family- 2 adults with/without children at school- $69
$
Individual- $64
$
Joint Senior Citizen- Retired Person 60 years or over plus one other person at same address- $50
$
Individual Senior Citizen- Retired Person 60 years or over- $45
$
Full Time Student/Unwaged- $45
$
Life Membership- $995
$
Joint Life Membership (2 adults at same address)- $1295
$
3. Select an Application Type
(New or Renewing)
This a
new
membership application?
I am a
renewing
member. My membership number is (if known)
4. Additional Services
Overseas Post
Do you live outside New Zealand? If you would like to receive the magazine, a $30 postage fee applies
$
Overseas Post:
Membership Card
To post your membership card outside New Zealand, a $10 postage charge applies
$
Express Service
(NZ only)
For $20 extra, we offer an express service. Express service guarantees 5-day turnaround for your application, posted to a NZ address
$
SUB TOTAL:
$
5. Donations.
Are you able to further assist the NZHPT's work by making a donation?:
P
lease specify amount
$
Donations over $100 are acknowledged by name in the NZHPT's magazine. Please tick this box if you do NOT wish your name to appear.
Your DONATION:
$
6. TOTAL
The GRAND TOTAL is the amount you will be charged
GRAND TOTAL:
$
7. Payment Details
Credit Card Type:
Mastercard
Visa
Card Number:
Cardholder Name:
Expiry Date:
Membership Services
NZ Historic Places Trust
Freepost 3206
PO Box 2629
Wellington, New Zealand
Fax: (04) 499-0669
(from outside New Zealand +64 4 499-0669)
If mailing please remember to include your remittance.