Registration Form

Charity name: * Email: *   Contact person: * Email 2:
Street Address   Physical street: * Town/Suburb: * Area/City: *		Mailing Address (if different)   Physical street: Town/Suburb: Area/City: P.O. BOX:
Business phone: 0907060304   Mobile phone: 021027029025   Fax: 0907060304

Purpose of the organization: *
Services provided by the organization: *
Services delivered to:
Method of providing the services:
Extended services with additional resources/funding:
Beneficiary story:
Social Statistics:

Website:		Clients per year:
Success Measure:	Qualitatively Quantitatively	No of full time staff:
Status:	Incorp society Charitable trust	No of voluntary staff:
GST status:		Revenue:
Tax status:		No of years operating:
Relationships:

Categories: *
Health General Research Mental Health Disibilities/Special Needs Youth Intervention Education/Development Recreational Development Welfare Abuse Addiction Budgeting Employment Information/Advice Relationships Accomodation/Housing Parenting Education Prisoners Suicide/Crisis Networks/Associations Support Groups At Risk Counselling Women
Locations: *
Auckland	Canterbury	Central North Island
Dunedin	East Coast	National
Northland	South Auckland	Waikato
Current Funding: *
Corporate Sponsorship	Foundations	Fundraising
Government Funding	Grants	Lottery
Previous Funding: *
Corporate Sponsorship	Foundations	Fundraising
Government Funding	Grants	Lottery