VANZ

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Thank you for applying for a membership to VANZ - Vehicle Association of New Zealand for People with Disabilities Inc.

Application for Membership to VANZ
Once your application is reviewed and accepted we will email you an invoice using the email address listed in the application. Please note that prices are inclusive of GST.

Please provide a valid email address as we will use that address to respond to your request.
* Email is required
* Retype Email is required
Please provide verifiable information
* First Name is required
* Last Name is required
* Representing Company is required
* Physical Address is required: Available characters:
Provide only if different from the physical address
Address for Correspondence: Available characters:
* Business Phone is required
Private Phone
Mobile Phone
Fax
Website
* What is the focus of your business? is required: Available characters:
Please select the number of products you would like to advertise on our website at $30.00 each. A VANZ representative will contact you shortly to discuss your advert (s).
Number of Adverts

Annual VANZ membership: New Member $25.00; Membership Renewal $25.00
Only VANZ members are eligible for paid links.: Link to Member Website $10.00
Please tick your preferred method of payment.: Direct Credit to bank account #030166-0406123-00; Cheque Payment to Po Box 32543, Devonport, Auckland

*Type each of the following words into the box below: