Membership Form Please fill out this form to either apply for FKNZ Membership or alternatively to update your details to keep us informed. Name* Mr.Mrs.MissMs.Dr.Prof.Rev. Title First Last Address* Address Address Line 2 City Postcode Phone (please include your are code)*Mobile Phone*Email* Ethnicity*Maori (please specify IWI below)NZ EuropeanSamoanTonganCook IslandNiueIWI (if applicable)Gender*FemaleMaleAgency I foster through*Site/Office of the agency I foster through*What kind of care do you provide?*RespiteEmergencyWhanau / KinTransitional / Short-termPermanency / Home for LifeFamily HomeI am...*a new membera current member updating my detailsStatement of MembershipBy completing this membership form and by ticking the checkbox below I agree that I have, read, understood and agreed to: • Abide by the vision and objectives of Fostering Kids New Zealand • Have my details retained by Fostering Kids New Zealand for statistical purposes • Receive newsletters and communications from Fostering Kids New Zealand • Fostering Kids New Zealand sharing my details and connecting me to my local foster care support association Yes, I agree. CAPTCHAEmailThis field is for validation purposes and should be left unchanged. Unfortunately at the moment we are experiencing technical issues with our Membership form. We hope to have this fixed shortly. Please contact 0800 693 323 to speak with someone about becoming a Member.