Practitioner Membership Renewal

Practitioner Membership Renewal

We look forward to receiving your application to renew your membership.

Please fill this form out carefully and completely and pay the membership fee. Failure to do so may result in delays in your renewal application while we try to contact you.

Membership Fees

The annual Practitioner Membership Fee is $125. Please pay via internet banking using our Kiwibank account 38-9009-0508274-00. In the “your details” section please include your initials and surname as the reference. On the anniversary of your membership you will be sent an invoice and will need to complete this membership application with evidence of continued education.

Part A


Part B

Have any of your details changed since your original application? Please submit any new information below.


Part C

If you would like up update the details shown in your Practitioner directory listing please submit
any new information below.

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Part D

Are you interested in assisting the association? If so, please tick:

 

joining the committeewriting articles for the websitementoring studentsassisting with publicity or marketingother - note below:

 

Part E

If you are reapplying for practitioner membership after less than 5 year’s absence, list your relevant continued education for the previous 12 months. Visit the FAQ page on our website for guidance if needed.


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I have paid the application fee via online banking. Kiwibank account 38-9009-0508274-00. In the 'your details' section please include your initials and surname as the reference.
The details I have submitted on this form and the documents/photocopies I have provided are true and correct. I acknowledge that I have read and fully understood the Code of Ethics and the Rules of Practice of the Clinical Nutrition Association and, if accepted for membership, I agree to abide by them.