Farm Day

Personal Details

Full Name *

Please enter your full name

Shareholder Number *

Please refer to the shareholder's list to find your number

Date of Birth *

Day Day12345678910111213141516171819202122232425262728293031

Month MonthJanFebMarAprMayJunJulAugSepOctNovDec

Year Year190519061907190819091910191119121913191419151916191719181919192019211922192319241925192619271928192919301931193219331934193519361937193819391940194119421943194419451946194719481949195019511952195319541955195619571958195919601961196219631964196519661967196819691970197119721973197419751976197719781979198019811982198319841985198619871988198919901991199219931994199519961997199819992000200120022003200420052006200720082009201020112012201320142015201620172018201920202021202220232024202520262027

Telephone *

Please enter your (area code) and valid telephone.

Mobile

Email Address *

Address *

Please provide your physical address where you live

Mailing Address *

Will you or your whanau be attending *

Yes

No

Do you/whanau have any dietary needs *

Vegetarian

Gluten Free

Dairy Free

None

Leave this field blank