Registration Form 2011

Section 1: Personal Data

Name Street Address Postal Address Email Phone Mobile

Section 2: Te Arawa Affiliations

Please tick those iwi/hapu from which you affiliate to: Ngati Kearoa Ngati Makino Ngati Ngararanui Ngati Pikiao Ngati Rangitihi Ngati Rangiwewehi Ngati Rongomai Ngati Tahu / Ngati Whaoa Ngati Tarawhai Ngati Te Roro o Te Rangi Ngati Tuteniu Ngati Tura Ngati Te Ngakau Ngati Uenukukopako Ngati Wahiao Ngati Whakaue Tapuika Tuhourangi Waitaha Unknown

Other _______________________________________________________________________________________ Which one of the above is your principal hapu? _____________________________________________________ Do you live in Rotorua? Yes No If no, where do you live?_____________________

Section 3: Demographic Statistics

Age 15 - 18 Gender Female Which best describes you? Secondary Student Other_____________________ Tertiary Student Working Male 19 - 21 22 - 24

Section 4: Areas of Career Interest

Please tick any of the following areas of career interest you have: Animals, Plants and Nature Engineering & Construction Arts and Media Health Business and Money Hospitality, Tourism & Beauty Distribution and Driving IT, Electronics & Electrical Education & Community Law & Protection Other _______________________________________________ Manufacturing & Craft Research & Knowledge Sales & Marketing Sports & Leisure

Section 5: Attendance Fee

$25 Sponsored/Working $15 - Student Scholarship

Scholarships are available to cover your attendance fees.

You can request a scholarship by outlining your reasons for wanting to attend the hononga and attaching this to your registration form.

Section 6: Special Requirements

To ensure you have a safe and enjoyable experience, please state any medical conditions or special dietary needs that we should be aware of: _____________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________

Section 7: Participant Code of Conduct

By signing this code of conduct, as a participant of the Te Arawa Rangatahi Hononga 2011 you agree to: (1) Respect the kaupapa, people, speakers, venue, resources and marae. (2) Attend and participate in the programme and activities appropriately. (3) Understand that the summit has a zero tolerance policy for any persons using alcohol and or drugs during the entire summit. If you are reported as using alcohol and or drugs during the summit you understand that, for those under 18 your parents/caregivers/guardians will be contacted immediately and/or the participant will be required to leave immediately.

Applicants Signature: ________________________________________ Date: ___________________________

RETURN OF REGISTRATION FORMS

Registrations close at 12 noon on Friday 15 July 2011. Please return you completed Registration Form along with your Attendance Fee.
Drop off to: Mail to: Email to: Te Pumautanga o Te Arawa Te Pumautanga o Te Arawa heidis@tpota.org.nz 8 Marguerita Street PO Box 6084 ROTORUA ROTORUA If you have any questions regarding your application you can contact Heidi Symon on 07 347 4615 or 021 911 305.