APGANZ Membership Application 
Please complete all details below. You need to submit an APGANZ member to endorse your application. Please contact admin@apganz.org.nz to discuss options if you don't know a member.
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Email *
Membership fee for 2024/2025:
Doctors $200
Non doctors $40
Students free
Once membership is approved, an invoice will be issued. Please contact admin@apganz.org.nz if you have questions.
First Name *
Last Name *
Date of Birth *
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/
DD
/
YYYY
Postal address *
Contact phone number  *
Current employer and Location of work
 *
Position/Profession (please select as many as needed)
 *
Required
Proposer who is an APGANZ member? 
This is required to help us verify new members
I authorise the verification of the information provided on this form
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