membership

Last name:

Postal code:

Phone/ cell:

Gender:

Ethnicity:

Profession:

Profession - other:

DHB:

Place of work:

Type of organisation:

Type of work:

Type of work - other:

Professioal interest area:

Professional interest area - other:

Percentage of time spent in youth health:

Post Graduate Education:

Medical Council Number:

Psychologist - Professional affiliation number:

Social Worker - Professional affiliation number:

Comments/questions

Personal profile - Optional
(you are invited to enter a brief
personal profile for inclusion on
the Profile page of the Membership section of the SYHPANZ website)

Other - Professinal affiliation number:

Please tick this Option if you would like to have you details shared with the SYHPANZ membership.
(Member's details that will be included are name, contact details, cell phone, organisation's details, and special interests and expertise)

First name:

Nursing Council Number:

Re-enter email address:

Age:

Email address:

Town/ Suburb:

City:

Address:

SYHPANZ Membership Fee

Join now and support the development of youth health as a specialist profession.

The SYHPANZ membership fee is $45

SYHPANZ Membership Form

SYHPANZ Membership
Payment Options

The membership fee can be paid by cheque to:

The Society of Youth Health Professionals Aotearoa New Zealand
c/o Dr Anganette Hall
SYHPANZ Treasurer
Vibe
PO Box 31 - 126
Lower Hutt

or to:

The Society of Youth Health Professionals Aotearoa New Zealand
Bank: Kiwibank
Bank Account: 38-9008-0230178-00