New Membership Application - Nelson Grey Power

Nelson Grey Power New Member Application Form

Please complete the following as completely as possible and then click the submit button found at the bottom of the form.

Membership Type

Individual Couple

First Name

Last Name

Year Of Birth

If You Are Joining Nelson Grey Power As A Couple Please Complete Second Person Details Below

Second Person First Name

Second Person Last Name

Second Person Year Of Birth

Please Provide Your Address And Contact Details

Street Number and Name

Suburb

City

Postal Code

Contact Phone Number

Email Address

Payment Details

After submitting the form please make payment by internet banking or by visiting the office at 33 Putaitai Street, Stoke.

Cost of Membership

Individual - $25.00
Couple - $35.00

Paying By Internet Banking

If making payment via Internet banking please ensure that you follow the instructions below:

1. Enter "New" in the 1st box
2. Initials and Surname (enter in the 2nd box and include both initials if a double membership)
3. Single or Double membership (enter Single or Double in 3rd box)

Nelson Grey Power's Bank Account Details Are: Westpac 03-1709-0071804-001.

Payments also accepted at McGlashen Pharmacy, Oxford Street Richmond and Triton Hearing – Bridge St.
A self‐addressed envelope with your postal payment would be appreciated to cut costs.

Nelson Grey Power New Member Application

How to Join Nelson Grey Power