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Membership > Membership application form

INDIVIDUAL MEMBERSHIP APPLICATION form

I am registering as a

Personal Member ($115.00)
Student Member ($57.50)*
Retired Member ($57.50)**

Surname
First name and middle initial
Show my title as
Show my position/job title as

Address (institutional addresses are preferred)

Employing institution and department (if not already shown)
Email address

Contact phone

Iwi affiliation

Pasifika affiliation

Please note my interest in Early Childhood Special Interest Group
Please tick the box if you do NOT want the above details included in a printed membership directory
Please tick the box if you do NOT want to receive research-specific any
information/mailouts
Research interests: Please indicate those research fields which are of greatest personal interest.
Hold down the CTR key (PC) or Command key (Mac) to make multiple selections.
Please select no more than 5 fields of interest as only the first 5 will be recorded.
If you have selected more than 5, please release the CTR or Command key and click on any category. Then reselect your 5 areas of interest.

Other research interests (please specify)
I will pay / have paid by



     

* A student member is enrolled in a tertiary institution at least half-time, and employed less than half-time.
** A retired member is over 59 years of age, and employed less than half-time.

   Last updated 25 August 2011   NZARE Secretariat • PO Box 3237 • Wellington • Email: admin@nzare.org.nz
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