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New Zealand Herpetological Society Inc.

Membership Form

To become a member of our society please complete the online form below, submit it, and send your payment to the Secretary NZHS.

Your contact details will be forwarded to our local representative.

You may pay directly to our bank account. In the banking details section please enter your name and "membership": TSB Bank 153948 0312862 00 .

Or please make cheques payable to: NZ Herpetological Society Inc., P.O. Box 3138, Fitzroy, New Plymouth 4341.

If you would like to be on the phone list to enable easier communication between NZHS members, please tick the box, and complete the “Phone – email” portion.

The contact list is published annually, and only those people on the phone list will receive a copy.

Rules of the NZHS contact list are:

1. The list is for use by listed NZHS members only. Its purpose is to foster communication within the NZHS.
2. Please do not make available this list, or any part of it, to any person not on the list.
3. Contact only members on the current list.
4. Phone at a reasonable hour.
5. You may be told things in confidence. Respect people’s right to privacy, and email security.

Membership Fees

Subscription from 1 June 2010 to 31 May 2011.

Name*
Address*
Postcode
Phone*
Email
Contact List (please tick, see above)
Membership Category*	Select OneFull Membership +Full MembershipStudent MembershipAssociate MembershipNZ Libraries +NZ LibrariesOverseas Membership
Amount Enclosed*
Current Permit Number (Required before obtaining lizards or placing ads in Moko to obtain lizards)
Please indicate if a) you have an interest in a particular reptile or amphibian
or b) if you keep any of these
Please select method of payment so that we may process your application more efficiently:*	Posting a cheque  Direct banking
	Please confirm that you are not a script by entering the letters from the image.