AMSNZ

Membership

Air NZ Plane

Thank you for your interest in joining the Society.

Any registered medical practitioner may apply to be a Full Member, if based in New Zealand or overseas. Applications for Associate Membership are welcomed from anyone who is not a registered medical practitioner, but who is involved in an aviation-based occupation or has other aviation-based interests.

Please complete the details below, and forward this form (with your cheque) to the Treasurer at the address shown. The subscription year ends on 31 March each year.

Annual subscription is currently $ NZ 100 per year which can be paid by cheque or by Direct Credit to the AMSNZ BNZ bank account : 02-0108-0092808-00 annotated with your surname.

Application for membership

To apply for membership you can simply fill out the form below and submit to us,
or download the PDF here. Then email your application to the Treasurer: This e-mail address is being protected from spambots. You need JavaScript enabled to view it

Or post to –
Dr. Anton Wiles,
PO Box 28306, Remuera,
Auckland 1541, NZ

AMSNZ Membership Aplication:

Please read the pdf application before completing this online form. This form will be electronically mailed to the Treasurer. (wiles@remueradoctors.co.nz) Subscriptions are $NZ100 due March 31^st annually but only $50 if joining after October 1^st.

Your title, initials, preferred first name and surname:

Date of Birth:

E-mail:

Postal Address:

Business Phone:

Private Phone:

Mobile Phone:

Qualifications, dates & specialty:

Other aviation medical experience:

Are you a NZ ME?:
NO YES

Are you an approved examiner for another country?:
NO YES

Which?

Pilot Licence, Rating (if applies):

Applying for Full membership Or Associate membership

Payment Method:
Cheque

Mail to Dr. Anton Wiles, PO Box 28306, Remuera, Auckland 1541, NZ

Direct Credit

To BNZ account 02. 0108. 0092808. 00 annotated with your surname.

Please check that all details are correct

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