Membership Application
First Name(*)
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Last Name(*)
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Physical Address(*)
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Mailing Address(*)
Please enter your complete mailing address

Website Address
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E-mail(*)
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Employer
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Position
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Membership Type Required(*)
Please select preferred membership type

If you are applying for Organisational Membership please complete, the following questions:
Organisation Name
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Organisation Address
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Organisation Registration Number
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Organisation Telephone
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List of additional members of your organisation wishing to join as part of this organisational application [please include email addresses too].
Additional Member Details
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I hereby apply for membership of the NZCAC and upon admission agree to pay member fees annually.I have read, understood and I agree to abide by The Rules of the Society and the NZCAC Member Code of Conduct
I have read and agree to the rules of the society and the society code of conduct(*)

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Statement of Interest(*)
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Upload Student ID Image
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Would you like to add a donation?
A donation, whatever the amount, will help make a real difference to the welfare of companion animals in New Zealand. You can make a donation below.
Donation amount:
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I understand that by submitting this form I will be deemed to have provided my signature
Name
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Date
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* indicates a field you must enter