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)		Your fees commence from the month in 2012 you are approved by the Board and cover the period until the following 31 December. Membership fees for the 2012 year are listed below and are pro-rated for members joining between February through to 31 December. Joining Fee ............................ NZD$172.50 (incl GST) (applies to all new membership applications from 1 May 2011) 2012 FULL ANNUAL SUBSCRIPTIONS: Individual Member.......................................NZD$402.50 (incl GST) Corporate......................................................NZD$460.00 (incl GST) Student & Retired........................................NZD$90.00 (incl GST) (For student memberships, please email a copy of your current student ID to office@boinz.org.nz)