Please tick the membership class you wish to join, Membership Classes and Fees on our information page.

[  ] New Zealand / International,   [  ] New Zealand Chapter only, [  ] Associate Membership,  [  ] Junior Membership,  [  ] NZ Family Membership,  [  ] NZ International Family Membership

Please fill in the form below and send to us by clicking on the submit button.
 

NAME:_____________________________________________________

ADDRESS:__________________________________________________

ADDRESS:__________________________________________________

CITY:_______________________________________________________

STATE:_____________________________________________________

POST CODE:________________________________________________

COUNTRY:__________________________________________________

PH DAY:____________________________________________________

PH NIGHT:___________________________________________________

EMAIL:______________________________________________________

Would you like to pay by Credit Card?
[  ] Yes   [  ] No. I am posting a cheque to PO Box 11320, Christchurch 8443

If you answered "Yes", please fill in the following...
Credit Card Type: [  ] Visa, or [  ] MasterCard
Cardholder's Name ________________________________________ 
Card Number ____________________________________________ 
Card Expiration Date _______________________________________ 

Please forward by email to scinz@xtra.co.nz, OR post to::
Secretariat 
SCI New Zealand
PO Box 11320
Sockburn
Christchurch 8443