Canterbury homebirth Association

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Address
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Phone
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I am interested in (please tick as appropriate):

	Attending the committee meetings
	Contributing a home birth story/photos to the Birthplace Magazine

Do these apply to you?

	I am planning/planned/have had a homebirth
	I am a midwife/student midwife
	Other

Payment Method

Direct Credit

I will pay the amount of NZ$ 30.00 direct to the Canterbury Homebirth Association.

Our bank account number is:

38 9010 0449312 00

Please enter your name as the reference and your phone number in the particulars field when you make the payment.

Cheque

	I will pay the amount of NZ$ 30.00 by cheque to the Canterbury Homebirth Association.
	Please make cheques payable to the Canterbury Homebirth Association.
	Enclose you cheque along with a printout of your completed form to:
	Canterbury Homebirth Association
	P O Box 2806
	Christchurch 8140
	New Zealand

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Canterbury Homebirth Association