Associate Membership Application

To apply for Associate membership please complete the following form.

You have privacy rights under Aoteoroa New Zealand, Australian and International Law. Go to the AANZPA Privacy policy to get information about your rights and how we protect your personal information.

First Name *

Last Name *

Informal Name

Pronouns

Email *

Contact Phone *

Address Line 1 *

Address Line 2

City *

State *

Postcode

Country *

Aoteara New Zealand

Australia

Birth Date *

Occupation

Qualifications

Professional Membership(s)

Sponsor Name *

Sponsor Email *

Training Campus *

Please read the following (links open in a new window):

I accept the AANZPA Conditions of Membership. *

Yes

No

I have read, understood and agree to comply with the AANZPA Code of Ethics. *

Yes

No

I have read this website's privacy policy and understand how my personal information will be used. *

Yes

No

I give permission for my contact details to be published in the AANZPA Inc. Members Directory and/or distributed to AANZPA Members.

Yes

No

Tick this option if you don't want you contact phone number shown on the Membership list on the AANZPA website.

Don't publish my phone number

Groundhogg Form

Associate Membership Application