Membership Application Form

NOTE:This form for is for Individual and Student Membership only. The form for Corporate Membership is under development.

This is an HTML form. You must have a browser that supports forms in order to use it. If you do not see text editing areas below, your browser does not support forms. In this case send e-mail directly to Rob.Pascoe@uniforum.org.nz.


Name:

Organisation:

Postal Address:

Phone:

Fax:

e-mail:

Subscription for one year:

Individual Membership at $85

Student Membership at $45

You will be sent a bill for this amount.

Attach Order number if required:

I do not wish to receive commercial mailouts

Submit application if all details are correct

Reset all details


This information is being collected to provide details for correspondence, mailing of newsletter, and other membership information, including commercial mailings from time to time, except where consent has been withdrawn.


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