Business Whangaparaoa Membership Form

Business Whangaparaoa Membership Application

* Indicates required field

Name *

First

Last

Email *

Business Name *

Physical Address *

Address to be publicly listed (if different) *

Phone Number *

Web Address *

Business Category (please choose one) *

Other (if you don't fit in the above) *

Company Blurb (50 words) *

Membership Options *

Early Bird Full Membership ($100 + GST) (49 remaining) Early Bird Associate Membership ($150 + GST) (68 remaining) Full Membership ($120 + GST) Associate Membership ($150 + GST)

Please can you also email us a copy of your logo - thank you

Comment *

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