Please fill out this form and then follow the payment instrucions at the end.

Note: Membership is for the period of 1st of January to the 31st of December 2010

* Name :

* Membership Number :

* Payment Method : Direct Credit Cheque

If any of your details have changed please let us know so we can update our records.

* Amount Paid :

* Please specify your age for MSNZ statistics Under 18 18 - 25 26 - 35 36 - 60 60+

Family Member Names (Please provide full names for membership cards)