Membership Application

	Membership Application

If you have any problems
or are unsure how to fill out this form
please email: enquiry@pibba.org.nz


	To apply for membership of PIBBA please complete and submit this form. This form will be emailed to PIBBA President: Esther Tofilau If you prefer a form to print and post click here Printable Membership Application * an asterix indicates information that must be entered
*Name
Email
*Address
*Phone
Mobile
*Date Of Birth	/ / 19 (day/month/year)
*Age	years old.
*Gender	Man	Woman
*Height	metres
*Weight	kilograms
Previous Titles
*Ethnic Group	N.Z. Maori Samoa	Tonga Cook Island	Fiji Niue Other
*Membership & Entry Fee	Paid	Unpaid
If you have any questions or comments write them here
	Please make sure this form is filled out completely. Name, Address, Phone, Date of Birth, Age, Gender, Height, Weight, Ethnic Group & Membership & Entry Fee are required fields and an error will occur if left empty