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PART 1 OF 5: PERSONAL INFORMATION
Registration #
*First name
Middle name
*Surname
*Date of Birth
(e.g. 03/01/2001)
Bank Account (paste bank
accounts with dashes only,
not spaces)
Bank Account Name
Gender
Wahine
Tane
Other/He ira ke ano
*Email
*Password
(minimum 8 characters
with 1 number, 1 upper and
1 lower case)
This will be your login password
*Confirm Password
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
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