Membership Application Click Here To Read Rules Of Engagement Membership Application * indicates required Group I am registering for TAURANGA MA11 TAURANGA SOUTH MA9* TAURANGA MA9 MOUNT MA11 TE PUKE MA9 THE LAKES MA9* MA11 PARNELL MA11 PAPAMOA First Name * Last Name * Email Address * Mobile * Applicant 2 - First Name * Last Name * Email * Mobile * Address * Address Line 2 City State/Province/Region Postal / Zip Code Country USAAaland IslandsAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntigua And BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Saint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandColombiaComorosCongoCook IslandsCosta RicaCote D'IvoireCroatiaCubaCuracaoCyprusCzech RepublicDemocratic Republic of the 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RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMoldova, Republic ofMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorwayOmanPakistanPalauPalestinePanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalQatarRepublic of KosovoReunionRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint MartinSaint Vincent and the GrenadinesSamoa (Independent)San MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks & Caicos IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUruguayUzbekistanVanuatuVatican City State (Holy See)VenezuelaVietnamVirgin Islands (British)Virgin Islands (U.S.)Western SaharaYemenZambiaZimbabwe Business Name * Industry Type * Accounting Legal Real Estate Bookkeeper/Admin Marketing Health Financial Services Beauty Counselling Mentoring Business Consultancy Services Business/Life Coach Massage Therapist Chiropractor Insurance Advisor Financial Advisor Mortgage Broker Business Banking Mobile Mortgage Manager Naturopath Recruitment Export Screen Printing Mobile/Broadband Services Online Shopping IT Services Food Services Copywriter Graphic Designer Personal Trainer Nutritionist Print Services Social Media – Facebook Social Media – Other Other Description of products or services Birthday / ( mm / dd ) Website Facebook Page Position * Director Manager Sales Other I have read and agree to the rules of engagement * Yes How did you hear about us? Friend Colleague Infuzed Member Google Search Social Media (e.g Facebook) Other Membership Options Std 6 Month ($29 per mth) Std 6 Month Up Front ($159) Std 6 Month Corporate/Couple* ($49 per month) Full 6 Month ($59 per month) Full 6 Month Up Front ($299) Full Corporate/Couple* ($99 per month)
