New Registrant Registration Form

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Question One: Email Address* This field is required.List your permanent email address below so that we can contact you if we require more information to process your application (We recommend using your permanent email address, not a work email, so that we can contact you about your registration if you change jobs in the future). By listing your email below, you are consenting to the AVPRC contacting you if required.
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Question One: Email address* This field is required.List your permanent email address below so that we can contact you if we require more information to process your application (We recommend using your permanent email address, not a work email, so that we can contact you about your registration if you change jobs in the future). By listing your email below, you are consenting to the AVPRC contacting you if required.
example@example.com
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Question Two: Email NewsletterThe AVPRC occasionally sends out email newsletters related to registration and regulation. If you wish to be included, select 'yes'. If you do NOT wish to be added to this email list, please indicate 'no' below.
Yes
No
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Question Three: Full Name* This field is required.List your name as you would like it to appear on the register. If you have a preferred name/nickname to include on the register, add this in parentheses after your legal name. Example: Margaret (Meg) Your middle name or initial must appear on the register to avoid confusion between people with the same first and last names. If you have changed your surname and would like your alternative surname to be listed on the register, indicate this by writing out your preferred surname followed by your secondary name in parentheses. Example: Jones (Martin)
First Name
Middle Name
Last Name
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Question Four: Qualification* This field is required.List the full name of your qualification, the year you obtained it and which educational institution you gain your qualification from. Only approved animal/veterinary physiotherapist qualifications can be included on the register
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Question Five: Proof of Qualification* This field is required.Please upload a copy of your qualification below. Suitable evidence must be a scanned or photographed copy of your qualification.
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Max. file size: 10.6MB
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Question Six: NZAVPA certificate upload* This field is required.Please upload your NZAVPA certificate to verify you have met the standard required. Please ensure you are uploading this certificate only. Any other certificate supplied here will not allow entry onto the register.
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Max. file size: 10.6MB
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Question Seven: NZAVPA certificate upload* This field is required.Please upload your NZAVPA certificate to verify you have met the standard required.
Contact phone number
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NZAVPA Membership* This field is required.As part of registering with the AVPRC, your NZAVPA membership will be verified to ensure your membership is current and in good standing. We will contact them directly to do this. Please confirm that you are a NZAVPA member and that you understand and consent to this information being verified. You can contact us directly at info@avprc.org.nz if you have any further questions regarding this.
YESNO
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Public register and information sharing

By submitting this application, you are agreeing to the Allied Veterinary Professional Regulatory Council (AVPRC) using your information for the purposes of establishing and maintaining your AVPRC registration. You consent to your name, registration number, qualification, and year that you qualified being included in the AVPRC register and published on the AVPRC website. Your information, including your email address, will not be used for marketing or shared with any other entity or person. You can withdraw from the register and have your information removed by emailing register@avprc.org.nz. This information complies with the New Zealand Privacy Act 2020.
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SignatureSign below to verify completion of this form.
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Registration fee for entry onto the AVPRC register
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