Application for Membership

HomeApplication for Membership

First Name *

Faculty *
Last Name *

Year Graduated *
Contact Details
Address

Address Line 1 *

Address Line 2

City *

Zip Code *

Country *
Phone: Home

Phone: Work

Mobile *

E-mail *
Membership (Select One)

Annual membership (individual) $20 Annual membership (husband & wife) $40 Life membership (individual) $100 Life membership (husband & wife) $150 Associate membership $10
Details of spouse if applying for joint membership:

First Name *

Faculty *
Last Name *

Year Graduated *

Phone: Home
Phone: Work
Mobile *

Email *

Do you/your spouse like to publish contact details in Association Web Page:

Yes No

Declaration
I/We agree to abide by the rules and regulations of the Association and work towards achieving the objectives of the association. My application fee is enclosed./ has been direct credited to the following NZAAUP bank account with my name as reference.

NZAAUP bank account No. 12-3287-0392059-00 [ASB Bank]