Application for Membership

- 1 November 1986

Name (Miss/Mrs/Ms/Mr)

Occupation :

Best mailing address :

Age :

Degrees and/or diplomas:

Honours :

Relevant areas of expertise:

Is there any manner in which you would be able to assist the Committee in furthering the aims of NZCSICOP? (e.g. providing expert opinion, public presentation, fund-raising, media contacts, newsletter contributions, etc.)?

Please tell us why you would like to become a member of NZCSICOP.

Please include your membership fee along with this application.

Annual membership: $10:00 (includes subscription to a quarterly Newsletter)

Sustaining membership: $100.00

Signature : Date:

Return this form to one of the following:

Dr David Marks, Chairman, NZCSICOP, Department of Psychology, University of Otago.

Dr Denis Dutton, Secretary, NZCSICOP, School of Fine Arts, University of Canterbury