Ngāti Apa Register

If you prefer not to fill this form out online, please download and the Ngāti Apa Registration (PDF - 92kb). Fill it out and return to the address printed at the bottom. Once we have recieved your form your registration will be confirmed.

Surname:		First Names:
Maiden Names:		Date of Birth:
Street Address:		Home Phone:
Suburb:		Mobile Phone:
City:		Fax:
Country:		Email:
Occupation:
Partners Surname:		Partners First Names:

Children Under 18 Years

Surname:	First Names	Gender (tick one)	Date of Birth
		M F
		M F
		M F
		M F

Marae - Tick the box for any marae you affiliate to. If you know your hapu, please print next to the appropriate Marae :

Kaungaroa
Parewanui
Tini Waitara
Whangaehu
Dont know

Which Marae will you vote with?(choose one for voting purposes)

Whakapapa

Whakapapa - Please show as much of your Ngāti Apa whakapapa as possible.


			(great-grandfather)
		(grandfather)
			(great-grandmother)

	(father)
			(great-grandfather)
		(grandmother)
			(great-grandmother)

(your name)
			(great-grandfather)
		(grandfather)
			(great-grandmother)

	(mother)
			(great-grandfather)
		(grandmother)
			(great-grandmother)

Declaration:
I acknowledge the introduction to this form and consent to the disclosure of my personal information to any body related to Te Runanga or its successor and I declare that the information above is correct.