Online Membership Form – Individual

Membership Category *

Title

Surname *

Initials *

Forenames *

Preferred forename

Date of Birth *

Home Address *

Preferred Email *

Alternate Email

Home Phone

Business/Term Address

Business Phone

Cellphone *

Position/Company

Preferred Mailing Address

Home
Business

Preferred Email Address

Home
Business

Are you now, or have you ever been, a member of Engineering New Zealand or affiliated Engineering New Zealand groups?

(If 'Yes', please provide Engineering New Zealand number

Please indentify your main areas of interest or send us a message using the space below

I wish to apply for membership of the Rivers Group and do hereby agree that, in the event of my admission, I will be governed by the Rules of the Rivers Group for the time being in force, or as they may hereafter be amended, and that I will promote the objectives of the Rivers Group as far as may be in my power. *

I Agree

Name