Membership Application form for Individuals

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Membership Application form for Individuals

Please complete the form below, select your payment method then click Next to submit your application.

You will be emailed an invoice for your membership subscription.

NOTE: Please use a * to indicate sections that do not apply to you. If you do not have a Business Email, kindly re-enter your main email address for that field to proceed with your application.

Personal Details

First Name *

Last Name *

Preferred Name *

Gender *

Date Of Birth *

Residential Address *

City *

Postal Code *

Country *

Region *

Personal Email *

Mobile Phone *

Industry Code (?) *

IIA Job Code (?) *

Qualifications

Tertiary Qualification *

Majoring in? *

If other - please specify

Global Qualification Serial Numbers (if known)

Business Details

Company *

Job Title *

Business Email *

Business Phone *

DDI Phone *

Newsletter Introduction

Please tick the box and use the field provided below,
if you wish to include a short bio in the next newsletter.

Other Memberships

If other specify here

E News Subscriptions

Newsletter

Situations Vacant

Global Updates

Event Email Notifications

Declaration

I request admission as a member to the Institute of Internal Auditors New Zealand and agree to comply with:

The Code of Professional Conduct including the
Code of Ethics available here

International Standards for the Professional Practice
of Internal Auditing available here

Our membership terms and conditions available here

Referees

Two Referees are required. It is preferable that one of these should be a member of the Institute of Internal Auditors New Zealand and the other a business referee. If you do not know a member of the Institute, provide two business references.

Referee 1

Name *

Position *

Company *

Address *

Telephone *

Email *

Member IIA?

Referee 2

Name *

Position *

Company *

Address *

Telephone *

Email *

Member IIA?

IIA Membership Subscription

Display in member directory?

Address my invoices to my organisation

Subscription Invoice Order Number

Subscriptions		Fee	Annual	Prorate
Individuals
	Professional Member	$50.00	$585.00	$97.50
	Associate Member	$50.00	$435.00	$72.50
	Associate Member - Student	$0.00	$0.00	$0.00
	Retired/On Leave Member	$50.00	$215.00	$35.83
Total				$0.00

Note

All prices exclude GST

Payment Method

Credit Card Pay on Invoice

Purchase Order Number

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