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1. Please enter a last nameLast Name: *
2. Please enter a first nameFirst Name: *
3. Please enter a valid email address.Email Address: *
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6. Please enter a cityTown / City: *
7. Please enter a PostcodeNZ Postcode: *
8. Please enter a Phone NumberPhone Number: *
9. Year that you were accredited:
10. Year that you retired:
11. Which publications would you like to receive for a 12 month period?
12. Publications

    Both publications: $38
    Aroha only: $20
    Mosaic only: $20

13. Aroha Mosaic
14. Donation (amount)
15. Yes, I would like to make an additional voluntary donation when I pay my membership fee (all donations over $5 are tax-deductible and you will receive a receipt for your payments)
16. Yes, please send me a free catalogue of childbirth, breastfeeding, parenting and nutrition leaflets and books that are available to purchase through La Leche League New Zealand

17. Please note: your membership application will be processed upon receipt of your payment into the following bank account (please use your full name as a reference for the transaction)

    ACCOUNT NAME: LLLNZ Inc

    BANK: BNZ

    ACCOUNT NUMBER: 02 0524 0098897 00

    If you wish to pay by VISA or Mastercard, please email details to subs[at]lalecheleague.org.nz

18. Answering the simple question below helps us avoid spam emails.
19. Please enter 'lllnz' in the box abovePlease enter the initials/acronym that is used to represent La Leche League of NZ in short form: *
20.