1. YOUR PERSONAL DETAILS *

Your Maiden Name (if applicable)

First Name

Last Name

Your Gender

Male

Female

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Date of Birth *

MM

DD

YYYY

Relationship status

Single

Married

De Facto

Civil Union

Prefurred Phone Number

Country

(###)

###

####

Your Preferred Contact Method

Phone

Email

Postal

None

2. TUPUNA

To be eligible to register with the Ngāti Rehua Ngātiwai ki Aotea Trust, you must be able to whakapapa or tatai to the founding tupuna by virtue of being descended from one or more of the following: a. Ranginui, the son of Hikihiki: and/or b. Rehua, the son of Mataahu and Te Kura: and/or c. Te Awe, son of Te Whaiti. Please select your Tupuna (if known):

Phone

Ranginui

Rehua

Te Awe

3. YOUR SPOUSE/PARTNER'S DETAILS

Your Maiden Name (if applicable)

First Name

Last Name

Your Gender

Male

Female

Date of Birth *

MM

DD

YYYY

5. YOUR CHILDREN/DEPENDANTS (under the age of 18 years)

Number of children/dependents

0

1

2

3

4

5

6

7

8+