Kaiapoi Promotion Association Membership Application
Annual Subscription from 1st April - 31st March
Select the Membership you are applying for:
*
Business / Company ($80)
Non-Profit / Charity Community Group ($40)
Associate Membership (Individual) ($40)
Contact Name:
*
First Name
Last Name
Business / Organisation / Group Name:
List your Business or Organisation on our Website?
*
Yes
No
Contact Email Address
*
example@example.com
Billing Email Address
*
example@example.com
Phone Number
*
Contact Person’s Number
Membership Address
*
Physical Address
Street Address Line 2
City
State / Province
Postal Code
Business / Organisation / Group, Details for the KPA website listing:
A brief outline of your Business / Organisation / Group:
0/200
Please upload your Logo (a square image is best if possible)
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of
Kaiapoi Promotion Association Constitution agreement
*
I agree to become a Member of the Kaiapoi Promotion Association and understand that my contact details will be added to the Membership Register
*
Submit
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