Registration

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-- Select -- Female Male

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-- Select -- Under 13 13-17 18-25 26-35 36-45 46-55 56-65 66-75 Over 75

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-- Select -- Not Stated New Zealand Maori NZ European/Pakeha African Australian British/Irish Cambodian Chinese Cook Island Maori Dutch Fijian Filipino German Greek Indian Italian Japanese Korean Latin American Middle Eastern Niuean Other Asian Other European Other Pacific Island Peoples Other Southeast Asian Polish Samoan South Slav Sri Lankan Tokelauan Tongan Vietnamese Other

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-- Select -- None Yes (Not Detailed) Physical Hearing Sight Intellectual Psychiatric Multiple Other

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-- Select -- Aranui Avondale Avonside Banks Peninsula Bexley Bromley Brooklands Burwood Christchurch NW Christchurch S Christchurch SE Christchurch SW Christchurch W Dallington Ferrymead Horseshoe Lake Kainga Linwood Marshlands New Brighton New Brighton North New Brighton South Other Ouruhia Parklands Phillipstown Queenspark Richmond Selwyn Shirley Southshore Spencerville Waimakariri Wainoni Woolston

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-- Select -- Yes No

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-- Select -- Aranui Avondale Avonside Banks Peninsula Bexley Bromley Brooklands Burwood Christchurch NW Christchurch S Christchurch SE Christchurch SW Christchurch W Dallington Ferrymead Horseshoe Lake Kainga Linwood Marshlands New Brighton New Brighton North New Brighton South Other Ouruhia Parklands Phillipstown Queenspark Richmond Selwyn Shirley Southshore Spencerville Waimakariri Wainoni Woolston

Required