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Individual Membership Registration

Individual Details

Title  *
First name  *
Preferred first name  *
Last name  *
Home address  *
City  *
Post code  *
Phone No.  *
Fax No. 
Mobile No. 
Date of birth.  *
Email address  *
Postal address  *


Employment Details

Organisation  *
Position  *
Postal address  *
City  *
No. of employees  *
Phone No.  *
Fax No.  *
Type of industry  *
E-mail address  *


Preferred Mailing Address

Please specify your interest 
Other postal address 


How did you hear about NZIM? 

Newspaper/Magazine 
Radio 
Email 
NZIM Website 
NZIM Brochure 
Other 


Business Interests 

Please specify your business interests

Leadership & Management 
Quality 
Business Skills 
Marketing 
Sales 
Communication 
Human Resources 
Information Technology 
Finance 
Others 

Registration Details


Please register me for 12 months individual membership as:
Full member $235.00 
Retired $110 
Student $115.00 
Overseas Rate $286.00 

The above rates are exclusive of GST in NZ Dollars.

Payment Details


Please invoice & post to 
Credit Card 
Card holder's name 
Card No 
Expiry date