ASNG Membership Application/Renewal Form

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Our membership year is the 1st April to 31st March the following year; the cost of an individual annual membership is $40.

Email *

Name *

Nursing qualification *

Post graduate qualification

Practicing certificate number *

Practicing certificate expiry date *

YYYY

School *

School address *

School phone number *

Are you an existing member *

Yes

Please list the person OR school name to be invoiced
*

If you are an existing member which cluster group do you belong to:

Northern

Central

Hauraki

Western

Northern Counties

Manukau

Eastern

Franklin

Southern

Clear selection

Are you working in a school funded by Te Whatu Ora? *

Yes

Thank you for your membership application/renewal, you will receive an email invoice shortly with more information.

Submit

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