IRMTNZ Long Term Member Certificate Order Form

IRMTNZ Long Term Member Certificate Order Form
IRMTNZ, PO Box 4122, Christchurch 8140.
GST Number 021-071-161
If you have been an IRMTNZ member for 40 years or more, CONGRATULATIONS!
(You can check the date of your registration on your original registration certificate and also at the bottom of your ‘online profile‘ in the Members Only area of the website).

If you wish to mark this achievement with a certificate, complete this form and pay the required fee by 30th April. Please do not print and post this form. Just click on ‘Submit’ at the bottom of the form once you have completed it and your information will be sent directly through to the Registrar.

Certificates are A5 (C5) size and cost $10 inc gst. They are issued once a year in May/June.
If you are a branch member, your certificate will be posted to your branch secretary for presentation to you at a suitable event. For non-branch members, your certificate will be posted directly to you.
Name*

First NameLast Name
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
YesNo
If you are a branch member, please enter the name of your branch.
I confirm that to the best of my knowledge I have been an IRMTNZ member for at least 40 years.
Payment Details

Unit price (ex GST ) $ 8.70
GST 15% $ 1.30

TOTAL TO PAY (inc GST) $ 10.00
Date Paid: *
Amount Paid*
Should be Empty: