Membership Application APGANZ Inc.
Please complete all details below
Email *
First Name *
Surname *
Date of Birth *
Phone *
Postal address *
Current employer/Place of work *
Position/Profession: *
Proposer who is an APGANZ member *
Proposer email address
Proposer phone number
I authorise the verification of the information provided on this form *
Membership fee for 2020-2021 is Doctors $100. Non doctors $40. Students free.
Please make any payments directly to our account, details below:
Bank: Kiwi Bank Account name: Abortion Providers Group Aotearoa New Zealand New Zealand Incorporated Account number: 38 9016 0847880 00
Reference SURNAME
Gst Reg: 117053059
A copy of your responses will be emailed to the address you provided.
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