PART 1 OF 5: PERSONAL INFORMATION

Registration #
*First name	*required
Middle name
*Surname	*required
*Date of Birth (e.g. 03/01/2001)	*required Please enter a valid date.
Bank Account (paste bank accounts with dashes only, not spaces)
Bank Account Name
Gender	WahineTaneOther/He ira ke ano
*Email	*required Please enter an Email
*Password (minimum 8 characters with 1 number, 1 upper and 1 lower case) This will be your login password	*required Password minimum 8 characters with 1 number, 1 upper and 1 lower case
*Confirm Password	*required Passwords must match
Postal Address
Postal Address Line 2
Postal Suburb
Postal City
Country	Aotearoa Australia United States of America
Post Code
Physical Address
Country	Aotearoa Australia United States of America
Phone (Home)
Phone (Work)
Mobile
Comments/Alias
Register children / dependants 18 years of age or younger

Existing Registration

Someone else has already registered with the same first name, last name and date of birth.  OK

Registration No

Leave blank for new registrations for system to auto allocate next registration no Cancel