Friends of Heritage Park

Application Form

Please complete the application form, print, and mail with your cheque to:

Norma Goodman

Treasurer, Friends of Heritage Park Charitable Trust

21 Horopito Road

Waikanae

New Zealand

If you would prefer to pay directly into our bank account here are the details.

Bank of New Zealand, Broadway Avenue Branch, Palmerston North

Branch 020719 account no 0026711 00

Account name is Heritage Park Rhododendron Charitable Trust.

If you use this option please put your phone number as your reference and let us know the date of your deposit

Name

Title First name

Last name

Are you paying by cheque Yes No

Are you paying by direct credit Yes No

Reference

Contact details

Address

Postal code

Phone number

Cell phone number

email

I enclose my cheque for NZ$30 payable to "Friends of Heritage Park"

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