N.Z. Institute of Hazardous
Substance Management (Inc)

Apply for Membership

Please fill in the form below or download and return our application form.

Corporate membership

Certain organisations may apply to be a Corporate member of this Institute. If you are interested in this category please contact the national office.

Online Application form

  1. Name  
                (First Name Surname)
  2. Employment
    Employer's Name:  

    Position and Contact Details:
    Position Held:  
    Full Time   Part Time  
    Other Duties:  

    Or Self-employed:
    Business Name:

  3. Preferred mailing address:

     

    Telephone Contacts:
    Business:

    Residential:

    Mobile:

    Facsimile:

    Email:

    Website:

  4. I have previously been a member of the Institute:   Yes     No  

    If NO: I am applying to be a :   Member     Associate member