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Online Registration Form

Name *

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Maiden Name if applicable. *

Date of Birth (DAY/MONTH/YEAR) *

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Mobile Phone Number *

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Email *

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Address *

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Whakapapa (Any information you might have about your children, parents, grand parents or great grand parents) *

Please fill in as much information as you can.

Choose your Marae affiliations (one or more accepted). *

I'm not sure - please help me. Mangatu Mokonui a Rangi Ngatapa Parihimanihi Pakohai Rangatira Rongopai Taihamiti Tapuihikitia Takipu Takitimu Tarere Te Waero o Kura Wainui Village

Choose your Hapu affiliations (one or more accepted). *

I'm not sure - please help me. Ngapotiki Ngai Tuketenui Ngariki Ngai Tamatea Ngati Wahia Te Whanau a Iwi Te Whanau a Kai Te Whanau a Taupara Te Whanau a Wi Pere

Private Notice Option *

I wish to receive any notices relating to general meetings and postal ballots so that I may vote on any elections, constitutional amendments, conversion or disposal of settlement quota. The notice will be sent to the address provided on this form.

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Declaration *

I declare that the information given in this application is true and correct and is to be used only for the benefit of Te Aitanga a Mahaki, for the benefit of Marae and Hapu of Te Aitanga a Mahaki, and for no other reason.

Carefully read this Declaration.

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