Service/Agency Affiliate Membership Registration

Access to the membership section will only be activated on approval of your membership and receipt of payment

Account information

Username: *

Spaces are allowed; punctuation is not allowed except for periods, hyphens, and underscores.

E-mail address: *

A valid e-mail address. All e-mails from the system will be sent to this address. The e-mail address is not made public and will only be used if you wish to receive a new password or wish to receive certain news or notifications by e-mail.

Section 1 - Affiliate Service/Agency Information

Service/Agency name:

Service/Agency fax number:

Service/Agency phone number:

Service/Agency email:

Management representative's name:

Management representative's position:

Management representative's contact cell phone number:

Postal Address:

Postal Address (2):

Suburb:

Town/City:

Postcode:

Country:

Section 2 - Special Character

Special character:

Maori immersion

Pacifica Language Nest

Special character (other):

Section 3 - tell us about your Service/Agency

Service Type: *

Are your office facilities: *

Are your playgroup facilities:

Do you provide a toy library:

Turnover:

Ownership:

Location Type:

Date of last ERO review:

Year:

Month:

Day:

OSCAR Approval:

CYF/MSD Approved:

Section 4 - Membership and payment details

Which region would you like to attend local meetings and events?:

How did you hear about NZHECEA:

How did you hear other:

Are you a member of any other national early childhood organisation? If so which one (please specify):

Tick which membership benefits you would like to access:

Group Purchasing Vehicles/Fuel/Stationary/other

Group Scheme Business Interruption Cover

Group Scheme Health Insurance

Group Scheme home/contents/car insurance

Group Scheme Income Protection

Group Scheme Public Liability

Group Scheme Statutory Liability

NZ Open Polytechnic NZHECEA Training Discount

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Service/Agency Affiliate Membership Registration

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