Membership Form

T1DT Membership Form

Please complete the form below to sign up to T1D Taranaki
T1D's Name

First NameLast Name
Second T1D's Name if applicable

First NameLast Name
Third T1D's Name if applicable

First NameLast Name
T1D's Birth Date

YearMonthDay
Second T1D's Birth Date, if applicable

YearMonthDay
Third T1D's Birth Date, if applicable

YearMonthDay
Parent or Legal Guardian (if registering with a child)

First NameLast Name
Second Parent or Legal Guardian (if registering with a child)

First NameLast Name
Spouse/Sibling/Dependant Names

First NameLast Name
Spouse/Sibling/Dependant Names

First NameLast Name
Spouse/Sibling/Dependant Names

First NameLast Name
Spouse/Sibling/Dependant Names

First NameLast Name
Main Contact's Phone Number:
Format: (000) 000-0000.
Emergency Contact

First NameLast Name
Emergency Contact Phone Number
Format: (000) 000-0000.
E-mail (for all up to date information)
example@example.com
Address:

Street Address

Suburb

City

Post Code
Are you interested in attending T1DT events?
How long has the T1D in your family been diagnosed?
What sort of things are you interested in getting involved with?

Other
- By joining T1DT, I confirm that I understand and agree to the following:
- I will be honest and accurate in all responses provided on this form.
- I will contribute to a supportive, inclusive, and respectful environment at all T1DT activities and events.
- I understand that I must not provide insulin or medication dosages or direct medical advice to others, unless I am a registered healthcare professional.
- I will respect the privacy, boundaries, and time of any professionals attending events in a social or volunteer capacity.
- I understand that T1DT is run entirely by volunteers, and I will be patient, kind, and respectful of the time and energy they give to make events and support possible.
- I will uphold the values of T1DT and help ensure it remains a safe, positive space for all members.
- I understand there is an annual fee of $10 per family or individual. This fee is to help with the running of T1DT and to protect our society from random sign up's.
I consent to photos being taken and used by T1DT
Type a question
Where did you hear about us?

Other
My Products
prevnext( X )
Family/Individual Membership
Annual Membership Fee. Memberships fees renew March. You will be reminded around this time each year. On renewal you will fill in the renewal form. $10 covers the whole family.

$10.00 NZD Quantity



First Year Free
New here? Awesome! If this is your first year with T1D Taranaki, just ignore the payment instructions and enjoy!

Free Quantity



Membership Renewal
Not your first rodeo? Perfect. Select

$10.00 NZD Quantity



Total

$0.00 NZD
Bank Details - please record these now for later use

TSB Bank
Type 1 Diabetes Taranaki
15-3953-0494138-00

Reference: Surname
Particulars: Initials
Should be Empty:

T1DT Membership Form

My Products