Associate Membership Application Form

Associate Membership Application
I am applying for Associate Membership with Summerfruit New Zealand, and agree to accept the decision of the Board as to whether I qualify for membership.

If my application is accepted, I agree to abide by the Rules of the Society.
Date*

MonthDayYear
Company Name*
Type of business
e.g. agrichemical company, supplier to industry, exporter, packhouse
Company Address*

Street Address

Street Address Line 2

Town/CityProvince

Postcode
Postal address (if different from above)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Representative's details
Representative's name*

First NameLast Name
Position with company
Contact Email*
example@example.com
Contact Phone Number *

Area CodePhone Number
The Privacy Act

The information you supply to Summerfruit NZ on this form is being collected to enable Summerfruit NZ pursue its objectives as set out in the Rules of the Society from time to time.

Natural persons have the right to access and correct personal information about themselves held by Summerfruit NZ.

Summerfruit NZ will not disclose the personal information supplied by you to any other person or agency.
I confirm that the information provided is true and correct.

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Associate Membership Application