Join MS Otago 2021 – Offline Payment

Name *

First

Last
Additional Family members or Organisation name
Email Address *
Choose your membership type:

Individual Annual Membership - $30.00 Family Annual Membership (up to 4 people) - $50.00 Corporate Annual Membership - $100.00 Your membership will be valid from 1 January 2021 to 31 December 2021.
Additional donation

$
Any donation helps us deliver our service.
Total

$ 0 This is the total amount to pay after submitting the form.
You can pay in two ways:

1. By bank transfer to 06-0911-0922057-00 using your surname as the reference.

2. By cheque made out to Otago Multiple Sclerosis Society
delivered to

MS Otago
Dunedin Community House
283 Moray Place
Dunedin 9016

Please include your name with the payment.