Your Full Name:

Your Address:

Date of Birth

Your Email ID:

Your Phone Number:

Name of Children Under 18 Year

Registration Amount NZ$ 20/Term23-25/ individual 18 years above. to be deposited in SNS's Bank account. Account Name: Southland Nepalese Society, Account Number 03-1750-0453388-00 please put your full Name in as reference.
Note: Your personal details are for membership registration purpose only. and will be kept confidential. if you have any suggestions write down in the bottommost, box or any query, please do not hesitate to contact on 0220499069.

The Southland Nepalese Society Inc of Southland, Membership Application/Renewal Form, filling by google form.
I declare that:
• I have been physically living in Southland, NZ and eligible to be member of the Society.
• I authorize Southland Nepalese Society Inc. of Southland to use my personal information for this purpose.
To administer this application for membership and for other activities of the Society.
• I understand that I have the right under the Privacy Act 2020 NZ replacing the Privacy Act of 1993 to access and correct my personal
information held by the Society.
• I agree that in the event of acceptance to the membership of the Society. i will be ruled by
Constitution and Regulations of the Society.
• I declare that the statements made in this application are, to the best of my knowledge, true,
complete and accurate.