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Membership Details
This is an application for:
General Membership
Corporate Membership
Student Membership
*
First Name *
Last Name *
Physical Address *
Suburb *
City *
Phone *
Mobile Number *
Email Address (Login) *
Name of Business or Employer *
Postal Address *
Position Title *
Is this position full or part time
Full Time
Part Time
*
Corporate Only - Nominated Contact Person - enter N/A for all other applications *
Corporate Only - Contact Person's E.mail - enter N/A for all other applications *
Corporate Only - List any other names from your organisation you wish to register for participation in NZISM activities - enter N/A for all other applications *
I/We undertake to ensure that the person/persons named in this application will abide by the NZISM Constitution and Code of Professional Behaviour
Yes
No
*
NZISM Branch (choose the branch that closest represents your location) *
Qualifications held in Occupational Health & Safety *
How long have you worked in the field of OH&S *
What is the main reason prompting you to join NZISM? *
Where did you hear about us? *
Other (please specify