Enquiries

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Please fill in the details below:

Full Name
Title	Mr Mrs Ms Miss
Day-time Phone Number
Fax Number
Email Address
Postal Address
City/Town
Enquiry
How may we contact you?	Email Phone Fax
How did you find out about the site? (Tick one)	Search Engine Printed Cancer Society material e.g poster Friend or Family Cancer Society Website
Please add me to the Cancer Society database so that I will receive email newsletters and other relevant information from the Cancer Society from time to time. I have read and understood the Cancer Society's privacy policy.
This form is for donations and membership subscriptions paid by cheque only. If you wish to pay by credit card please click here and fill in your details. Please post all cheques to Waikato/Bay of Plenty Division of the Cancer Society of New Zealand (Inc), PO Box 134, HAMILTON or deliver to your nearest Cancer Society office.
I would like to:
Become a regular donor	Yes! I am interested in regularly supporting the work of the Cancer Society. Please include me on your donor database so that I will receive your biannual newsletters and requests for financial support. I would like to start today and I will post a cheque for $
Become a member	Yes! I would like to become a member of the Waikato/Bay of Plenty Division of the Cancer Society of New Zealand Inc. and receive bi-annual newsletters, the annual report and be eligible to attend the AGM.
	I/we wish to apply for an annual family membership for $15.00 I/we wish to apply for an annual individual membership for $10.00
Make a one-off donation	I/we wish to make a donation of $
Make a Daffodil Day donation	I/We wish to make a donation for Daffodil Day of $
Make an In Memoriam donation	Name of deceased Amount of In Memoriam donation:$
Become a Daffodil Day volunteer	Yes I would like the Daffodil Day coordinator to contact me about helping out on Daffodil Day. My nearest Cancer Society office is: Tauranga Rotorua Hamilton
Become a sponsor	Details:
Raise funds on behalf of the Cancer Society	Details: