1
Associate Membership Application Form
1. Full Declaration
I, the applicant, desire to be elected as an Associate Member of the New Zealand Planning Institute.
I declare that if my membership application is approved I will abide by and observe the provisions of the
Constitution and Regulations, that I will pay the subscriptions prescribed and that all the particulars given in this
application and accompanying STATEMENT OF EXPERIENCE are true and correct to the best of my knowledge and
belief.
Surname:
First Name:
Job Title:
Email address:
Business Phone Main:
DDI Phone:
Home Phone:
Mobile:
Billing Address:
Company:
Street or Box:
Suburb:
Country:
City:
Postcode:
Postal Address: Company:
Street or Box:
Suburb:
Country:
Name of Qualification:
City:
Postcode:
Date of commencement and completion:
University at which you studied:
Name of any other Professional body you are a member of?
Are you an existing member of NZPI, if so what membership category?
Your signature:
Date:
2
2. Sponsor Declaration
By signing this application form, I the Sponsor, a Full member of NZPI acknowledge that
(Full name of applicant)
is personally known to me and that I am of the opinion that the applicant satisfies the conditions necessary for
membership. As Sponsor I understand that the NZPI® Membership Convenor may phone me personally to discuss
the application.
Surname:
First Name:
Email address:
Mobile:
Landline:
Sponsor’s signature:
Date:
3
3. Supporter Declaration
First Supporter
By signing this application form, I the Supporter, being a Full, Grad4+ or Associate member of NZPI, acknowledge
that
(Full name of applicant)
is personally known to me and that I am of the opinion that the applicant satisfies the conditions necessary for
membership. As Supporter I understand that the NZPI® Membership Convenor may phone me personally to discuss
the application.
Surname:
First Name:
Email address:
Mobile:
Landline:
Sponsor’s signature:
Date:
Second Supporter
By signing this application form, I the Supporter, being a Full, Grad4+ or Associate member of NZPI, acknowledge
that
(Full name of applicant)
is personally known to me and that I am of the opinion that the applicant satisfies the conditions necessary for
membership. As Supporter I understand that the NZPI® Membership Convenor may phone me personally to discuss
the application.
Surname:
First Name:
Email address:
Mobile:
Landline:
Sponsor’s signature:
Date:
4
4. Statement of Experience
(To accompany Associate membership application form)
By:_________________________________________________________________________
(Full Name in BLOCK LETTERS. Underline Surname)
Please give details of your interest and involvement in planning.
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
5
Statement of Experience
(To accompany Associate membership application form)
By:_________________________________________________________________________
(Full Name in BLOCK LETTERS. Underline Surname)
Please give details of your interest and involvement in planning.
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
6
5. Applicant Authorisation
I authorise the Institute to disclose and/or use the above information for purposes relating to the Institute’s
Constitutions, Regulations and Policies. For membership purposes, the New Zealand Planning Institute®
is authorised to approach my Sponsor to collect information and discuss this application. The Sponsor is authorised
by me to disclose whatever information the Institute may require to consider this application.
I authorize NZPI to disclose my phone number or email address upon any reasonable request:
Name of Applicant:
Signature of Applicant:
Date:
*The New Zealand Planning Institute® undertakes to collect, use and store the information provided on these
forms according to the principles of the Privacy Act 1993
The office often receives enquiries from people wanting to contact members. To enable such people to make direct
contact, please tick the boxes below for the information you are comfortable being shared with others.
I authorize NZPI® to disclose the following information over the telephone at the request of the general public.
(Tick the relevant boxes)
Work Number
Mobile Number
Email Address
Please scan and email your completed forms to [email protected]
Or
Post to Membership Liaision Officer at PO Box 106-481, Auckland City 1143.
OFFICE USE ONLY
Forms Completed
Application Form

Statement of Experience

Sponsorship
A full current NZPI® member is required as a Sponsor. Supporters are current members (Full, Graduate 4+, Associate)
Sponsor eligible
Y N
Supporter 1
Y N
Supporter 2
YN
Secretariat
Date application forwarded to CEO:
Date application received from CEO:
Date
Date
_____/_____/_____
_____/_____/_____
Application Approved
Y N
Approved by:____________________________Signature:_____________________________
7
8