ASNG Membership Application/Renewal Form
Our membership year ends in May; the cost of an individual annual membership is $40 (if joining after January membership is $20).
* Required
Name
*
Your answer
Are you an existing member
*
Yes
No
If you are an existing member which cluster group do you belong to:
Northern
Central
Hauraki
Western
Manukau
Eastern
Franklin
Southern
Nursing qualification
*
Your answer
Post graduate qualification
*
Your answer
Practicing certificate number
*
Your answer
Practicing certificate expiry date
*
MM
/
DD
/
YYYY
School
*
Your answer
School address
*
Your answer
School phone number
*
Your answer
Work email
*
Your answer
Home email (only if you wish to receive ASNG correspondence through this)
Your answer
Thank you for your membership application/renewal, you will receive an email shortly with more information.
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