Membership Application

Submitted by Anonymous on Sun, 2009-05-24 14:05.

This is the on line Membership application form:

Membership will not be confirmed until receipt of your membership fee.

Membership Fees can be remitted to:

Membership Secretary,

Private Bag MBE - P290,

Auckland

Internet Transfer Bank A/c – 03-0510-0731460-00

Personal or Organisation Details

Personal or Organisation Name: *

Conatact person for Organisation:

Address 1: *

Address 2: *

Address 3:

Address 4:

Post Code:

Phone Number: *

Cell Phone Number:

Email: *

Membership Type

Membership Type: *

Individual ($50)

Organisation ($200 for 3 networks + $20 per network above 3)

Region: *

Addtional information for Individual Members

Name of Organisation associated with::

My role is::

Payment Method

Payment Method: *

By Cheque

By Internet Bank Transfer

CAPTCHA

This question is for testing whether you are a human visitor and to prevent automated spam submissions.

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