Your details

Please fill in every field of this application form. You will not be able to submit your application if any field is left blank. Enter N/A if any field does not apply to your application.

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* 1. Name of applicant or applicant organisation

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* 2. Postal address (postcode must be included)

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* 3. Telephone (Include area code)

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* 4. Mobile

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* 5. Email Address

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* 6. Website

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* 7. Are you a New Zealand Citizen or Permanent Resident?

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* 8. Are you or is your organisation GST registered?

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* 9. If yes, please provide GST number

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