Service/Agency Affiliate Non-MOE Membership Registration

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

Account information

Username: *

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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/Institution Information

Service/Agency/Institution name:

Service/Agency/Institution fax number:

Service/Agency/Institution phone number:

Service/Agency/Institution email:

Management representative's name:

Management representative's position:

Management representative's phone:

Management representative's mobile number:

Postal Address:

Postal Address (2):

Suburb:

Town/City:

Postcode:

Country:

Section 2 - Special Charachter

Special character:

Maori immersion

Pacifica Language Nest

Special character (other):

Section 3 - tell us about your Service/Agency

OSCAR Approval:

CYF/MSD Approved:

Description:

e.g. baby sitting agency/training provider/Govt dept/home based OSCAR provider

Location Type:

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):

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Service/Agency Affiliate Non-MOE Membership Registration

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