Membership Application

Please indicate the type of membership that you are applying for

Membership Type

Full

Student

Associate

Please enter your details

First Name

Last Name

Preferred Name

Date of Birth

Are you registered by the Optometrists & Dispensing Opticians Board?

Yes

No

Please give your date of registration and registration number.

Date of Registration

Registration Number

Are you a member of any other optician's organisation?

Yes

No

Other Organisation Name

Your Contact Details

Most correspondence is by email through the Member News and direct emails.

Work Contact Details

Work Email Address

Work Phone

Name of Practice

Postal Address of Practice

Post Code of Postal Address

Physical Address of Practice

Post Code of Physical Address

Personal Contact Details

Personal Email Address

Personal Phone

Personal Address

Post Code of Personal Address

Region

Where would you prefer to receive ADONZ communications?

Work Email

Personal Email

All information will be treated as confidential to the Executive Council
Membership will be approved upon receipt of confirmation of registration or student status
An invoice will be emailed to you once your application has been processed

I hereby make formal application for admission to Membership of the Association of Dispensing Opticians of New Zealand Incorporated and I declare that to the best of my knowledge and belief, the statements herein are true and complete in particulars. I further declare and undertake that, if elected a member of the Association of Dispensing Opticians of New Zealand Inc, I will observe and abide by all of its Rules and Regulations. I also comply with the terms and conditions and privacy policy outlined on this website.

Declaration

I agree.

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