Membership

The benefits of being a Spinal Support NZ Member

Spinal Support NZ invites membership inquiries from individuals living in the Central North Island from Gisborn to the far North. Our current membership covers a broad spectrum of the community.

Spinal Support NZ membership entitles you to the following:

The Supporter quarterly newsletter featuring new and views for & by people with spinal concerns. All newsletters now available online in PDF format
Although the Spinal Support NZ committee meetings are ordinarily restricted to elected committee members, any other financial member of Spinal Support NZ may request in writing to the Spinal Support NZ president for an item to be included on the agenda and may be invited by the president to attend for an allocated time slot for the purpose of submitting the item in person and for consideration by the full committee.
Members can use our Van which is only available if our patients are not requiring them for trips home etc.,
There are Terms and conditions. Please contact the Spinal Support NZ Office.
It’s fast and easy to become a member, simply complete the form below and deposit the annual membership fee of $10, or pay $200 for life membership the annual renewal date for Spinal Support NZ membership is 31st October.
- For online payments, the Spinal Support NZ bank account number is 12-3082-0076255-01
  Please put your name in the Reference section and ‘Membership’ in the Particulars section.

Click here to download the membership form

Or you can complete this online form

Spinal Support NZ Membership Form

1. PERSONAL DETAILS
I would like to * Required
- Become a new member
- Update my details
Although filling in your address and phone number may not be required for some options, we encourage you to complete these details. Your local Coordinator can then inform you about any social events or Gatherings organised in your area.
Name * Required
First Last
Address * Required
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Gender * Required
- Male
- Female
- Other
Marital Status: * Required
- Single
- Married
Date of Birth * Required
DD slash MM slash YYYY
Name of Partner/Contact:
Dependents * Required
2. CONTACT DETAILS
Home
Work
Mobile
Email * Required
3. MEDICAL DETAILS
Is your injury due to an accident? * Required
- Yes
- No
Level of Injury: * Required
Complete / Incomplete
Date of Accident: * Required
DD dash MM dash YYYY
Please briefly describe how the accident occurred: * Required
Is your injury due to medical reasons?
- Yes
- No
Level of Injury: * Required
Complete / Incomplete
Date of Condition: * Required
DD dash MM dash YYYY
Please briefly describe medical condition: * Required
4. OTHER (Optional)
Nationality:
Citizenship:
Religion:
Do you smoke?
- Yes
- No
Do you drink?
- Yes
- No
Occupation(s):
Hobbies / Interests:
Describe your Personality: (check which ones you feel apply to you)
- Friendly
- Outgoing
- Easygoing
- Shy
- Reserved
- Positive
- Other (please specify)
Please specify your Personality
Describe your attitude towards life: (check which ones you feel apply to you)
- Conservative
- Middle of the Road
- Broadminded
- Other (please specify)
Please specify your attitude towards life
5. BUDDY
Would you like a Buddy? * Required
- Yes
- No
Is gender important? * Required
- Yes
- No
Is age important? * Required
- Yes
- No
ACC/MOH issues relevant? * Required
- Yes
- No
Is nationality important? * Required
- Yes
- No
Religion? * Required
- Yes
- No
Further Comments
I would like to receive a copy of the information I have submitted
- Yes
- No