Membership Step 1 of 4 25% Membership Option*Membership Prices from 1st September – 31st August Parafed Waikato is a non-profit organisation. The society’s goal is to improve life quality for Waikato physically disabled and visually impaired through active participation in sport and recreation. Membership Cost: Full Membership - $35.00. Full membership is required by all those seniors (19 years and over). This includes social athletes who only participate in sport at local training sessions as well as athletes who wish to compete at events/games/nationals and/or wish to apply for club supported funding. This also includes coaches and officials who wish to apply for financial assistance from us. Junior Membership - $20.00. Junior membership is for individuals aged 18 years and under or still at school. These members have “full membership” rights. This also includes junior coaches and officials. Social Membership - $20.00. Social membership includes those who are supporters, volunteers, family members as well as athletes who only participate in our fitness revolution programme. Full Senior MemberJunior MemberSocial MemberTotal $ 0.00 Payment MethodCredit Card / Debit CardBank TransferCredit Card American ExpressDiscoverMasterCardVisa Card Number Month010203040506070809101112 Year20182019202020212022202320242025202620272028202920302031203220332034203520362037 Expiration Date Security Code Cardholder Name Bank TransferPlease pay the total amount owning into our bank account, using your last name and membership type as the reference. Our account number is 03-1556-0072418-000. Name* Mr.Mrs.MissMs.Dr.Prof.Rev. Title First Last Date of Birth*GenderMaleFemaleEthnicity (Optional)Email Phone*Enter your contact phone number here.Mobile PhoneEnter your contact phone number here.Emergency Contact PersonEmergency Contact PhoneAddress* Street Address Address Line 2 City ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSaint MartinSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country Communication Channel Select All Email Phone Newsletter Impairment/Physical disability:Wheelchair User Yes No N/A Classification Yes No N/A Classification details:NZ Paralympian Yes No N/A Current schoolSportsSelect (+) to choose more than one sport and sport status.Sport NameSport Status Adaptive rowingBlind CricketBocciaCyclingFitness RevGoalballHalberg GamesLawn BowlsPara ClimbingPara TriathlonPowerchair FootballRock ClimbingShootingSwimmingWheelchair BasketballWheelchair RugbyWheelchair TennisN/APlayerCoachAssistant CoachReferee/OfficialManagerSupporter/VolunteerCommittee MemberInterested inN/A SportsAdaptive rowingBlind CricketBocciaCyclingFitness RevGoalballHalberg GamesLawn BowlsPara ClimbingPara TriathlonPowerchair FootballRock ClimbingShootingSwimmingWheelchair BasketballWheelchair RugbyWheelchair TennisN/ASports StatusPlease select your involvement with each sport: PlayerCoachAssistant CoachReferee/OfficialManagerSupporter/VolunteerCommittee Memberinterested inN/AList any sports or programmes you want to be involved in Parent / GuardianIf you are under the age of 18, please enter your parent / guardian's name. First Last Parent / Guardian Phone
