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. Please enter N/A if you do not foster through an agency.*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. CAPTCHAPhoneThis field is for validation purposes and should be left unchanged.