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wellington gltbi community

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Membership Form

Membership valid till December 2010

Please use our online form below to register your membership. You could also download our form (word document) and post it to Rainbow Wellington, P O Box 890, Wellington
Use the tab key to navigate & complete all fields. Highlighted fields are required. 08/09/2010 16:40:20

Personal Information:
Please enter a desired login name:
Choose
Password: 		Email address: (Newsletters are sent here).
First name: Surname:
Address: Suburb:
City: Pin code: (Nos only)
Select Country: Phone: (Nos only.

Membership Options - Select preferred membership
   
The Directory is an on-line schedule of Rainbow Wellington member businesses on the Rainbow Wellington Website.
  • Corporate Membership provides 3 Rainbow Wellington individual membership cards and:
  • Listing on the Rainbow Wellington website Business Directory
  • Profile in the fortnightly Rainbow Wellington electronic newsletters
  • Advertising services and/or events in Rainbow Wellington newsletters and /or mail outs
  • A link to your website from the Rainbow Wellington website
For smaller businesses not requiring Corporate membership, the Individual with Directory Listing membership option provides a listing in the Rainbow Wellington Business Directory on the Rainbow Wellington website.

Business Detail:

Address: Contact name:
Phone / Fax / Mobile: Email / Website:

Payment Options:

Select a payment option: We prefer payment by direct credit: Please pay by internet banking to Rainbow Wellington, WestPac, Account No: 03-0566-0164688–00. You will also receive an email with our account details plus registration confirmation.
If you choose to pay by credit card: You will be directed to our secure payment gateway for payment and returned to this website on completion, where you will be emailed a registration & payment confirmation.
Enter verification number : 8965
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