Become a financial Member of Tongan Health Society Inc Applicant Details: Voting Member Name * First Name Last Name Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Phone * Date of Birth MM DD YYYY Email address * Membership type * if family membership list family members below – maximum number is 6 only Individual Family Name and Date of Birth Name and Date of Birth Name and Date of Birth Name and Date of Birth Name and Date of Birth Name and Date of Birth Declaration * I understand that my application will be submitted to the THS Board before membership is considered according to the THS Consitution. I wish to be a financial member of the Tongan Health Society Inc including any dependents listed on my enrolment above. The contents of this form have been explained to me in the Tongan language where I have requested futher. I have paid the prescribed fee for financial membership to the Tongan Health Society Inc and I understand that I will be liable for an annual renewal fee as determined by the Tongan Health Society Board Inc. Membership is subject to the following terms and conditions (compulsory questionnaire) 1. All members must be a NZ Citizen Resident (evidence of residency / citizenship needed) 2. Do you have any outstanding payments to the Society? * Yes No 3. Have you been a previous member? * Yes No 4. If yes, since when / number of years of membership 5. Are registered at Langimalie clinic? * Yes No 6. If yes, which clinic? Kelston Panmure Onehunga 7. Why do you want to be a member of the THS? * Thank you!
