When depositing funds into Blind Citizens NZ’s bank account to renew your membership, please let our National Office know. You can post this form to PO Box 7144, Newtown, Wellington 6242, phone us on 0800 222 694 or email us at admin@blindcitizensnz.org.nz

As a reference, please include the first letter of your Christian name and full surname, and the reference “MembSubs”. Blind Citizens NZ’s bank account details are: 06-0230-0002634-00.

Full Name: (Mr/Mrs/Miss/Ms): ________________________________

Address: _______________________________________________________

___________________________________________________________________________________________________________________

Email ___________________________   Phone No: ____________

Date of Birth: _______________   Ethnicity: _________________

I prefer to receive information (select preferred format):
Braille | Audio | Large Print | Email

Membership subscriptions for Ordinary and Associate Members are $10 per year, or $30 per year for those who can afford it. Please select and indicate the amount you are paying from the options below.

• Ordinary Membership – for blind | deafblind | low vision and vision impaired (blind) members registered with or eligible to receive full services from Blind Low Vision NZ: $10  or  $30.
• Associate Membership – for family | friends | whanau: $10  or  $30
• Membership-for-Life is available to those who meet the criteria for Ordinary Membership: $300.00

I include a donation $________ for National Office | Branch | Network.