New Membership :: Sign up Form

*   Required items

First Name:*

Last Name:*

Address:* Type in your Street Number and Street Address only. Eg. 123B Paddle Avenue, Green Street,

Rural District: 1 2 3 4 5 6 7 8 9 10

Town:* Carterton Eketahuna Featherston Greytown Hamilton Martinborough Masterton Wellington Taupiri

Post Code:*

Find your Postal Code

Home Phone:* 03 04 05 06

Mobile:* 021 022 027 028 029

Email:*

Date of Birth:* Please enter your DOB in this box like so: yyyy-mm-dd Eg: 1962-08-27

NZMS Membership:   If already a NZMS member

Preferred Stroke:* Fly Back Breast Free IM Open Water

Preferred Distance:* 50 100 200 400 800 1500

Password:

Choose a password you will use each time you log-in

Password Confirm:

Enter password again to check for parity