Membership Application Form
       
Membership type:    
       
Personal Details:    
Surname: First Name:
Title: Relationship:
Ethnicity:    
Is English a second language?  
If yes, what is your native language?  
       
Partner / Spouse:    
Surname: First Name:
Title: Relationship:
Ethnicity:    
Is English a second language?  
If yes, what is your native language?  
       
Contact Details:    
Address:
  Street / RD / PO Box   Suburb
 
  City / Town   Postcode
Telephone:      
Home: Work:
Mobile: Fax
Email:  
       
Professional or Organisational Members Only  
Organisation: Profession:
       

Please supply details of person with an autism spectrum disorder
Name: Date of Birth:
Name: Date of Birth:
Name: Date of Birth:
         

Under the Privacy Act we are obliged to make sure that all information we record is not incorrectly assigned to someone else with the same name, therefore we need your child’s date of birth to uniquely identify your membership.
 

Autism New Zealand Inc. has branches throughout the country. Your contact details will automatically be passed on to your nearest branch so they can provide you with information on local support through their newsletter.

One FREE Parent Pack is available to each family on joining. If you have not already received a Parent Pack, then please choose which information you would like:

 

Ways you can help

Please contact me about volunteering
Please send me information on making a regular donation
Please send me a FREE copy of the ‘Guide to Making your Will’
Please send me information on making a bequest to Autism New Zealand
 

Annual membership voluntary donation

Receipt of services is not dependent on your making a donation; however whatever support you can afford is greatly appreciated.  As a charitable organisation Autism New Zealand relies on donations to help fund the information and services provided. The suggested minimum annual donation is $20.00

I would like to donate $
 
 

Your Privacy - We will record your information to keep you advised about opportunities for training and provide you with information and for statistical purposes.   We may contact you from time to time with opportunities to assist Autism New Zealand with fundraising and other activities. This information may be accessed only by designated staff and branch committee members and you have the right to inspect and update the details at any time.   Please write to us at PO Box 42052, Tower Junction, Christchurch 8149 or email us at info@autismnz.org.nz if you wish to check your details or do not wish to receive further information and offers.
 

Benefits of membership of Autism New Zealand Inc.

  • Membership of your local branch who can provide some of the following: support groups, seminars, training programmes and a local newsletter.
  • You will receive our quarterly national newsletter, and monthly e-news letter if you provide an email address
  • You will be entitled to obtain articles from our Resource List which includes thousands of articles on autism spectrum disorders from New Zealand and overseas.
  • You will receive any new information, training or news that may be of interest.
  • You have the opportunity to vote or stand for membership of the National Board (which governs Autism New Zealand) and for your local branch committee.
  • Help and advice is only a phone call away from either your local branch or the national office.
 
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