AFFILIATE athlete membership form

To confirm your Affiliate Membership to Blind Sport New Zealand, please complete ALL applicable fields of the below form, and return to Blind Sport New Zealand with your Affiliation Fee (NZD$20.00).

Affiliation Fee should be deposited via Electronic Funds Transfer to:

Account Name: Blind Sport New Zealand Incorporated
Account Number:
03-0195-0325293-00
Reference:
SURNAME, AFEE

Name *
Name
Date of Birth *
Date of Birth
Address *
Address
Declaration *