Kerala Cultural Community Hawke's Bay Incorporated

Family Membership

Become a member today and start making a lasting impact!

Full Name*

Spouse Name*

Email Address*

Emergency Contact(India)*

Mobile*

Blood group

Post Code*

Spouse Mobile*

Spouse Email*

Address*

Children's Details

No	Name	Relationship	Age	Action
1				Add Child

Are you a member of any other Malayalee Association in NZ?

Yes

If Yes, Please give details

Referred by

Have you completed payment, if 'yes' how?*

Payment completed online

Cash Paid to an Executive Committee memberof KCC Hawkesbay

If paid in cash, please give the name of the Exe. Member who received your payment

I hereby declare that I authorise KCC to share my personal information above to a third party who formally partners with the organisation or other beneficiaries for the benefit of Kerala Cultural Community Hawke's Bay Inc and its activities.

Do you have any questions?

Yes

If yes, please provide details:

How would you like to contribute to the betterment of KCC and its activities?

Would you like any support or guidance at this stage?

If yes, please tell us more:

We, the undersigned members of KCC Hawkesbay, hereby declare our commitment to the mission and purpose of the organization, and pledge to adhere to its guidelines and promote its objectives to the best of our abilities.

Bank Details Of Kcc Hawke's Bay

Account Name:	KERALA CULTURAL COMMUNITY-HAWK E'S BAY INCORPORATED
Account No:	02-0644-0237142-000