1. Contact Information
Name of Organisation(*)
Please type your full name.
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Address
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City
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Post Code
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Telephone
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Contact person for membership
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Job title
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Email(*)
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2. Legal Information
Associate membership shall be open to either: (a) any Service Provider holding a current relevant government contract, which in the sole discretion of the Executive Committee has compatible objectives to the Association or (b) any group, society or association that may not provide services but whose objectives are compatible with those of the Association.

Please describe what services you provide or how you consider your organisation’s objectives are compatible with those of SSPA:
(*)
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Charities Registration Number(*)
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3. Service Information
MSD Agreements: List your contracted services or programmes (e.g. Information & Advice Services)
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Non-MSD Contracts: List any contracted services or programmes (e.g. MOJ: safety services for domestic violence victims)
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4.Operational Information
Years of operation
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Geographic Reach
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Annual Budget and Funders:
MSD
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MOJ
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DHB
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Other
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Other
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Ethnic Focus


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Other
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Number of staff:
Staff
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Volunteers
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Total FTE
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Number of clients in previous year:
Individual (child, clients, parents)
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Group (family)
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Agency/Organisation
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5. 5. What benefits do you want from SSPA Membership? (e.g. regional networks, advocacy, information
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Membership Options (GST inclusive):
Please choose one of the following options.
Member Organisation’s Budget(*)
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Payment Method
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(*)
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