Application for Membership

To be completed by the applicant

* All mandatory fields must be filled in

Section 1 - Personal Details

Surname*
First Names*
Addresses	(Please select the address you want your mail sent to)
	Residential*		Company*

Home Phone*		Company Name*
Home Fax		Current Position Held
Home Email*		Work Phone*
		Work Email*
		Work Fax
Describe duties undertaken in current position


Membership Class*		Membership Fees
(Please select the membership class you are applying for)		Individual Member.......................................NZD$250.00 (inc GST) Corporate......................................................NZD$460.00 (inc GST) Student & Retired........................................NZD$90.00 (inc GST) (For student memberships, please email a copy of your current student ID to office@boinz.org.nz)