Name . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Position. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Organisation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Mailing Address . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Phone . . . . . . . . . . . . . .                                     Fax . . . . . . . . . . . . . . . . . . .

Other Address . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Mailing Address: Home ( ) Work ( )
E-mail address. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Occupation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Iwi Affiliation (if applicable). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Membership Type:

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Membership Fees Payable for the Year to December 2008
Members with an income over $20,000 pa if paid BEFORE 1 April 2008, $60 (  ) otherwise $65 (  )
Members if income less than $20,000 pa $20 (  )
Subs for THREE years $160 (  )

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NZAIA Newsletter options (please tick one as appropriate):

Send with your sub. to : The Secretary, NZAIA (Inc.), PO Box 2581, Wellington

We are compiling a list of those who have special interest or experience in different aspects of impact assessment.

To help us with this, please fill in the form below by ticking all of those boxes which apply.

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