WPBN MEMBERSHIP APPLICATION

MEMBERSHIP APPLICATION
BUSINESS DETAILS
Wellington Pasifika Business Network
REGISTERED NAME
TRADING NAME IF DIFFERENT FROM ABOVE
NAME OF OWNER/S:
AFFILIATION WITH PACIFIC ISLAND NATION STATE ALL
TYPE OF BUSINESS:

SOLE TRADERPARTNERSHIPCOMPANY
GST REGISTERED

YESNO
DATE STARTED BUSINESS (MONTH AND YEAR):
REASON WHY YOU STARTED YOUR BUSINESS
INDUSTRY SECTOR - (TICK ALL THAT APPLY)
GOODS-PRODUCING INDUSTRIES

MANUFACTURINGENERGYWATERWASTE SERVICESCONSTRUCTIONARTSEDUCATIONOther
PRIMARY INDUSTRIES

AGRICULTUREFORESTRYFISHING
SERVICE INDUSTRIES

WHOLESALE TRADEACCOMMODATIONFOOD SERVICE/HOSPITALITYRETAIL TRADETRANSPORTWAREHOUSINGITMEDIATELECOMMUNICATIONSFINANCE AND INSURANCERETAIL HIREAGEREAL ESTATE SERVICESOWNER-OCCUPIED PREPERTY OPERATIONPROFESSIONAL CONSULTANCY SERVICESADMINISTRATION SUPPORT SERVICESHEALTHEDUCATIONARTSNON FOR PROFITINCORPORATED SOCIETYCHARITABLE TRUSTOther
ASSET VALUE
YEARLY TURNOVER
LOCATION
CONTACT DETAILS
PHYSICAL ADDRESS
POSTAL ADDRESS
WEBSITE
PHONE
EMAIL
example@example.com
PRIMARY CONTACT
NAME
JOB TITLE
EMAIL
example@example.com
DDI
KEY CONTACTS
NAME
JOB TITLE
EMAIL
example@example.com
DDI
NAME
JOB TITLE
EMAIL
example@example.com
DDI
NAME
JOB TITLE
EMAIL
example@example.com
DDI
STAFF DETAILS
PERMANENT EMPLOYEES: NUMBER OF:
FIXED TERM EMPLOYEES
PERMANENT EMPLOYEES
INDEPENDENT CONTRACTORS
VOLUNTEERS
HOW DID YOU HEAR ABOUT THE WELLINGTON PASIFIKA BUSINESS NETWORK
TERMS AND CONDITIONS AS AGREED BY THE MEMBER
I/We hereby make an application to become a member of WELLINGTON PASIFIKA BUSINESS NETWORK (WPBN I/We agree to pay the annual membership fee of $50 + GST. I authorise you to send me an invoice. I/We accept that WPBN may, in its absolute discretion, decline this application without giving reasons. I/We agree that if our application is successful, we will provide WPBN with such information as required for joining the membership. I/We also agree to the following specific terms and conditions: 1. I/We will advise WPBN in writing if we want our membership to be kept confidential. 2. WPBN collects personal information and information about your business to monitor, analyse and evaluate statistical data to assist us to tailor our services to suit our membership. 3. I/we agree that WPBN may forward our membership details to WPBN approved third parties, either to effectively manage, and analyse membership data or, to identify service providers who may offer products and services which could assist members to develop their business. 4. I/We agree that if for any reason we are dissatisfied with our membership or any services provided by WPBN we will, before withdrawing membership or taking any other action, first notify the Executive Officer. On request I/we will meet with WPBN with a view to discussing any matters that may require resolution.

WPBN complies with the Privacy Act 2020 (the Act) and the Unsolicited Electronic Messages Act (the EM Act) when dealing with personal information. WBPN collects personal information from you so that we can help you to promote, strengthen, support, and grow, as a Pasifika entrepreneur, ultimately to deliver positive outcomes to Pasifika peoples. Any information we collect about you is necessary for the purposes of WPBN's work and is treated in a confidential and trusted way, in accordance with the Information Privacy Principles outlined in the Act. WPBN's Online Privacy Statement and Privacy Policy may be amended as legislation is revised, from time to time. Updated policies will be uploaded to the WPBN website for you to peruse and our practices amended in line with the requirements of the Act. If you wish to seek further information on the Act, please contact us directly, or visit the Privacy Commissioner's website at www.privacy.org.nz

Email: VPBNEnquiries@wpbn.org.nz Website: www.wellingtonpasifikabusinessnetwork.com
We wish to apply for membership of the Wellington Pasifika Business Network and agree to abide by its conditions of membership.
NAME
TITLEPOSITION
SIGNATURE
DATE OF APPLICATION

MonthDayYear
Date
The WPBN will contact you with information about networking events, workshops, seminars and learning and development opportunities.

The WPBN will email you with the regular WPBN newsletter.

Please let us know if you would like us to promote your business on WPBN's various social media platforms (LinkedIn, FaceBook, Instagram

Please return the form upon completion to WPBNEnquiries@wpbn.org.nz and click on the link below to set a date/time to have an in-depth talanoa about your business needs, in person, or, via Zoom, or, Teams. https://calendly.com/wpbn

Email: Natasha.Jacobs@wpbn.org.nz

Website: www.wellingtonpasifikabusinessnetwork.com
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MEMBERSHIP APPLICATION

BUSINESS DETAILS

Wellington Pasifika Business Network

INDUSTRY SECTOR - (TICK ALL THAT APPLY)

CONTACT DETAILS

PRIMARY CONTACT

KEY CONTACTS

STAFF DETAILS

PERMANENT EMPLOYEES: NUMBER OF:

TERMS AND CONDITIONS AS AGREED BY THE MEMBER