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Affiliate Membership

Qty. 1

$345.00

Total $345.00

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Have you been subject to, or are you under professional investigation by an organisation for which you are employed or contracted to or a professional body either in New Zealand or overseas?*

Yes No

Have you been convicted of any criminal offence punishable by imprisonment of a term of 3 months or longer? For New Zealanders note your rights under the Criminal records (Clean Slate) Act 2004 before providing any details of any criminal record.*

Yes No

Are you aware of any criminal investigation or charges pending against you in New Zealand or overseas?*

Yes No

Are you aware of any investigation pending or proceeding against you by the police?*

Yes No

Is there any additional information you believe is pertinent to any disclosure in this declaration - this may be submitted on a separate piece of paper or if you may request a confidential meeting with a member of the membership committee to discuss in private.*

Yes No

Completing this check box confirms your signature to the above.*

Member Details

First Name *

Last Name *

Preferred First Name *

Email *

Confirm Email *

Alternative Email *

Phone *

Alternative Phone *

Gender *

Age Range *

Ethnicity *

Please specify your ethnicity *

Address *

Suburb

City *

Postcode

Country *

Who is paying for your membership? * Company payment Self payment

Employer Name

Purchase Order Number (optional)

Password *

Your password must be a minimum of 8 characters long.

Confirm Password *

Billing Details

Billing details same as member details?

Bill to *

Address *

Suburb

City *

Postcode

Country *

Billing Email

Membership Information

Which branch do you want to join? *

Employment Status *

Job Title

Have you been expelled from or denied membership to NZISM or any other health and safety professional organisation in the past? * Yes No

Why are you joining NZISM? *

Where did you hear about NZISM? *

Your Industry *

Please specify your industry *

Have you ever been an NZISM member? Yes I have been a member before

Additional Documents

Student Membership Applications Only: attach evidence you are studying full time on a course recognised for accreditation by NZISM. * Upload Files

Acknowledgement and Agreement

I confirm I have read and agree to be bound by and observe NZISM's Rules, the Code of Ethics and the Complaints Process. *

I confirm I have read and acknowledge the Privacy Policy. *

I would like to receive emails and updates from NZISM.

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By becoming a member, you'll receive newsletters via email from NZISM.

Subscribe to our Mail List

Thank you for joining the Women in Safety Excellence (WISE) network.

We hold various online and face-to-face events throughout the year and if one occurs near you, we would love to meet you in person.

LinkedIn - Please make sure you join our LinkedIn group to stay connected and on top of our planned webinars and events. We encourage you to post anything in the WISE group page that you think other network members would find useful or inspiring. Please don't be shy. The more we reach out, the more we connect with each other, and the more we can help each other on our journeys.

We might send you the occasional email but our web page on the NZISM website is always the best place to go for an overview of what's coming up in the WISE calendar.

Best wishes,

Margaret van Schaik

WISE Chair