Membership Application

1. Contact Information
Name of Organisation(*)
Please type your full name.
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Address
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City
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Post Code
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Mailing Address (if different)
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Telephone
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Contact person(*)
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Role(*)
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Email(*)
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Additional Email(s)
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You can add other email addresses to receive e-newsletters
Website
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2. Legal Information
Charities Registration Number
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Evidence of contract
Level of approval
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Please provide either
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Contract/Agreement (pdf)
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Only pdfs can be uploaded.
Contract year end
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3. Service Information
MSD Agreements: List your contracted services or programmes (e.g. Information & Advice Services)
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Non-MSD Contracts: List any contracted services or programmes (e.g. MOJ: safety services for domestic violence victims)
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4.Operational Information
Years of operation
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Geographic Reach
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Annual Budget and Funders:
MSD
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MOJ
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DHB
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Other
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Other
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Ethnic Focus?


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Other
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Number of staff:
Staff
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Volunteers
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Total FTE
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5. What benefits do you want from SSPA Membership? (e.g. regional networks, advocacy, information)
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Membership Options (GST inclusive):
Please choose one of the following options.
Member Organisation’s Budget
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(*)
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