Membership form

Hearing Wellington

Become a member and support the lives of Wellingtonians with "hearing problems"

I/We wish to join the Wellington Hearing Association Inc.

Find us at

Persons name *

First name

Last name

Home phone

Cell phone

Email address

Preferred contact method

Signature *

Amount *

Total amount

Pay method *

Bank transfer
Make deposit to account
We will email you the details once the form is complete

Pay at reception
Please inform the receptionist if you wish to pay your membership fee by cash or EFTPOS