Pūtahi Manawa - PortalPutahi Manawa

Application Form

Name

First Name

Last Name

If you chose "Other" in the question above, please let us know your institution or organisation here

You may enter self-employed if that applies, or not relevant if you are joining as a private individual for affiliate membership

Job Title

You may enter not relevant if you are joining as a private individual for affiliate membership

Why is enhancing equity in health outcomes for Māori, for Pacific Peoples and for women important to you?

What are the areas of interest, work, research, skills and experience that you would bring to Pūtahi Manawa as a member?

Please list which social media platforms (if any) that you would like to connect on.

Please attach your CV (Not required for affiliate membership).

Code of Conduct

I have read the Pūtahi Manawa Code of Conduct and confirm that I will abide by it.

Newsletter Opt In

I would like to subscribe to the Pūtahi Manawa Newsletter

Privacy

I acknowledge that the personal information collected here is only used by Pūtahi Manawa staff for the purposes defined at the time of the collection or a use that complies with these purposes.
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