Online Membership Form – HBC Genealogy

Online Membership Application Form

Instructions:
• Fill in the form below and press the Submit button at the bottom
• Make your payment to ASB Bank account 12-3046-0188698-00 (make sure you include your name)
On receipt of payment you will be acknowledged by E-Mail including a “Welcome Letter”

Hibiscus Coast Branch of the NZ Society of Genealogists

By submitting this form, you are agreeing to provide personal information. This information will be used solely for branch-related purposes and will NOT be shared with third parties.

Title (Mr / Mrs / Miss / MS etc)*

Surname*

First Names*

Preferred Name

Postal Address*

Phone Number*

Email*

Do you belong to the NZSG? If yes please enter your membership number

How did you find out about us?

Any comments you wish to add

EMERGENCY CONTACT DETAILS
In the event of any unexpected emergency it would be appreciated if you could advise us of the details of
whom we should contact on your behalf.

Contact 1 Name

Contact 1 Relationship

Contact 1 Phone Number

Contact 1 email

Contact 2 Name

Contact 2 Relationship

Contact 2 Phone Number

Contact 2 email

HEALTH
Is there any information that you would like to share with us in the event that we need
to seek medical assistance for you? (Conditions, Allergies, medications, GP details?)

Health Information