Name *

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

TYPE OF MEMBERSHIP

Full Member

Associate Member

Name of Representative 1:

First Name

Last Name

This representative comes from a refugee background

Representative 1's Phone

(###)

###

####

Name of Representative 2:

First Name

Last Name

This representative comes from a refugee background

Representative 2's Phone

(###)

###

####

Are you interested in having a representative on The Refugee Alliance Strategy / Steering Group?

YES

NO

We’d like to find out more

Are you interested in having a representative attend quarterly Zoom meetings with other members to hear updates and progress from The Refugee Alliance?

YES

NO

We’d like to find out more

As a member, would your organisation like their logo added to The Refugee Alliance website?

If you would like us to include your logo on our website, please email your logo to info@refugeealliance.org.nz

YES

NO