application form

Name:
Organisation and title:
Address:
Phone:
Fax:
Email:
Please indicate the type of membership you require by ticking the relevant boxes below.
Individual:	Waged NZ$20 - Unwaged NZ$5
Family:	NZ$25
Organisation:	Please use PDF version of this form
Total amount:
Tick here if you do not want to be on the email list

Post to: Living Streets Aotearoa, PO Box 25-424, Wellington, New Zealand

Please enclose your cheque to Living Streets Aotearoa.