Become a forum Member

Application to Become a Forum Member

Please complete the form below

Name of Organisation *
Address *
Postal Address (if different from above)
Phone *
Email *
President
Administrator
Treasurer
Secretary
Is your local organisation an Incorporated Society / Trust?*
Yes
No
Is your organisation registered for GST?*
Yes
No
Does your organisation have a national body?*
Yes
No
If Yes, please provide a GST number
Has your organisation received funding from the MoH in the past?*
Yes
No

How many paid staff do you have?

Position
Position
Type
Full Time
Part Time
Type
Full Time
Part Time
Position
Position
Type
Full Time
Part Time
Type
Full Time
Part Time
How does your organisation conform as a not for profit organisation and give details of your primary focus of working with people with a disability? *
As part of your group’s application to become a forum member the Trust (trustees & forum groups) invite you to attend a Trust meeting to tell the Trust about your organisation and to answer any questions that Forum Members may have. Are you prepared to attend a Trust meeting for this purpose?*
Yes
No
As a Forum Member Group, you are expected to participate in Forum activities. This includes attendance at quarterly Forum meetings. Is your organisation prepared to make this commitment?*
Yes
No
What is the name of the person that will represent your organisation at these meetings? *
As a part of the monitoring requirements of the Ministry of Health, the WBoP Disability Support Trust surveys the members of Forum Groups on an annual basis. Is your organisation prepared to support and undertake this task?
Yes
No
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Our organisation:

wishes to become a member of the Western Bay of Plenty Disability Support Trust.

Name of Applicant
Please tick to confirm
Date
Name of Witness
Date
Please tick to confirm
The above information may be shared with other existing forum group members. Please attach any other relevant information and return your completed form to the Coordinator at WBOP Disability Support Trust, P O Box 15466, Tauranga 3144 or email coordinator.wbop.dst@gmail.com
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(Relevant information could be for example, a copy of your strategic plan, business plan and annual accounts/auditors report). Thank you for your interest in joining the forum.

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