Become a financial Member of Tongan Health Society Inc 

Name *

First Name

Last Name

Phone *

(###)

###

####

Date of birth

MM

DD

YYYY

Membership Type *

(if family membership list family members below – maximum number is 6 only)

Individual

Family

Declaration *

I understand that my application will be submitted to the THS Board before membership is considered according to the THS Consitution.

I wish to be a financial member of the Tongan Health Society Inc including any dependents listed on my enrolment above.

The contents of this form have been explained to me in the Tongan language where I have requested futher.

I have paid the prescribed fee for financial membership to the Tongan Health Society Inc and I understand that I will be liable for an annual renewal fee as determined by the Tongan Health Society Board Inc

2. Do you have any outstanding payments to the Society

Yes

No

3. Have you been a previous member

Yes

No

5. Are registered at Langimalie clinic

Yes

No

6. If yes which clinic

Kelston

Pamure

Onehunga