Application for Corporate Membership

Application for CORPORATE membership.
* denotes a compulsory field, it must be completed before your form will be submitted successfully

The [name of organisation]: *

has an interest in the practice/study/teaching/ application of risk management

management and wishes to apply for corporate membership of the New Zealand Society for Risk Management.

Please list names and email addresses of staff in your organisation wishing to be a corporate member. A maximum of 25 people can be listed.

Primary Contact Details

* Your 'Primary Contact' and 'Other Contact' details will be routinely displayed only to the Society's membership, in secure PDF website listings. Should you wish to suppress the display of any individual's name and their contact details, please select the corresponding 'No' checkbox alongside their details.

Primary Contact

Title: *

First Name: *

Surname: *

Email: *

DDI phone: *

Publish Name:

Yes

Job title: *

Please provide the postal address for this organisation. This is the address that invoices will be sent to.

Address: *

Corporate Member details [1]

Title:

First Name:

Surname:

Email:

DDI phone:

Publish Name:

Yes

Job title:

Corporate Member details [2]

Title:

First Name:

Surname:

Email:

DDI phone:

Publish Name:

Yes

Job title:

Corporate Member details [3]

Title:

First Name:

Surname:

Email:

DDI phone:

Publish Name:

Yes

Job title:

Corporate Member details [4]

Title:

First Name:

Surname:

Email:

DDI phone:

Publish Name:

Yes

Job title:

Corporate Member details [5]

Title:

First Name:

Surname:

Email:

DDI phone:

Publish Name:

Yes

Job title:

Corporate Member details [6]

Title:

First Name:

Surname:

Email:

DDI phone:

Publish Name:

Yes

Job title:

Corporate Member details [7]

Title:

First Name:

Surname:

Email:

DDI phone:

Publish Name:

Yes

Job title:

Corporate Member details [8]

Title:

First Name:

Surname:

Email:

DDI phone:

Publish Name:

Yes

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Corporate Member details [9]

Title:

First Name:

Surname:

Email:

DDI phone:

Publish Name:

Yes

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Corporate Member details [10]

Title:

First Name:

Surname:

Email:

DDI phone:

Publish Name:

Yes

Job title:

Corporate Member details [11]

Title:

First Name:

Surname:

Email:

DDI phone:

Publish Name:

Yes

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Corporate Member details [12]

Title:

First Name:

Surname:

Email:

DDI phone:

Publish Name:

Yes

Job title:

Corporate Member details [13]

Title:

First Name:

Surname:

Email:

DDI phone:

Publish Name:

Yes

Job title:

Corporate Member details [14]

Title:

First Name:

Surname:

Email:

DDI phone:

Publish Name:

Yes

Job title:

Corporate Member details [15]

Title:

First Name:

Surname:

Email:

DDI phone:

Publish Name:

Yes

Job title:

Corporate Member details [16]

Title:

First Name:

Surname:

Email:

DDI phone:

Publish Name:

Yes

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Corporate Member details [17]

Title:

First Name:

Surname:

Email:

DDI phone:

Publish Name:

Yes

Job title:

Corporate Member details [18]

Title:

First Name:

Surname:

Email:

DDI phone:

Publish Name:

Yes

Job title:

Corporate Member details [19]

Title:

First Name:

Surname:

Email:

DDI phone:

Publish Name:

Yes

Job title:

Corporate Member details [20]

Title:

First Name:

Surname:

Email:

DDI phone:

Publish Name:

Yes

Job title:

Corporate Member details [21]

Title:

First Name:

Surname:

Email:

DDI phone:

Publish Name:

Yes

Job title:

Corporate Member details [22]

Title:

First Name:

Surname:

Email:

DDI phone:

Publish Name:

Yes

Job title:

Corporate Member details [23]

Title:

First Name:

Surname:

Email:

DDI phone:

Publish Name:

Yes

Job title:

Corporate Member details [24]

Title:

First Name:

Surname:

Email:

DDI phone:

Publish Name:

Yes

Job title:

What are your organisations particular areas of risk management interest?: *

Do you have any questions you would like to ask about the NZSRM? Please provide details here.:

We agree to abide by the Constitution of the NZ Society for Risk Management: *

We agree

Click this liink to view the Constitution of the New Zealand Society for Risk Management.

Primary contact to print (before clicking the register button) and sign this form, and post it to:

Rachel Allan (Administrative Officer)
New Zealand Society for Risk Management
PO Box 5890
Welington, 6145

Has this form been printed and signed ready for posting?: *

Yes I have printed and signed the completed form