Annual Membership Registration – NZILLI

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Annual Membership Registration

ANNUAL MEMBERSHIP

Registration

Please use this form to register up to 10 inspectors. If you are registering more than 10, then you will need to submit multiple forms.

Payment is by direct credit only.
The registration fee is $100 per inspector for annual membership only.
Details will be provided once you have submitted this form.
NZILLI is not GST Registered. NO INVOICES WILL BE GENERATED.

If you are human, leave this field blank.

ANNUAL MEMBERSHIP RENEWAL

Purchase order number (optional)

Total number of inspectors you are registering *

Total fee payable *

Please fill in the total as indicated in red.

1 Inspector

Total registration fee : $100.00

2 Inspectors

Total registration fee : $200.00

3 Inspectors

Total registration fee : $300.00

4 Inspectors

Total registration fee : $400.00

5 Inspectors

Total registration fee : $500.00

6 Inspectors

Total registration fee : $600.00

7 Inspectors

Total registration fee : $700.00

8 Inspectors

Total registration fee : $800.00

9 Inspectors

Total registration fee : $900.00

10 Inspectors

Total registration fee : $1000.00

Territorial Authority *

Email address to receive a copy of this registration *

Postal Address *

Name of inspector 1 *

Job title *

Phone number *

Email *

Is this the Chief Licensing Inspector? *

YES

NO

First time registering as a member? *

YES

NO

If YES > Attach a copy of full warrant (including responsibilities and powers)

How many years have you been an inspector at your current territorial authority? *

How many years have you been an inspector over all your career? *

Name of inspector 2

Job title

Phone number

Email

Is this the Chief Licensing Inspector?

YES

NO

First time registering as a member?

YES

NO

If YES > Attach a copy of full warrant (including responsibilities and powers)

How many years have you been an inspector at your current territorial authority?

How many years have you been an inspector over all your career?

Name of inspector 3

Job title

Phone number

Email

Is this the Chief Licensing Inspector?

YES

NO

First time registering as a member?

YES

NO

If YES > Attach a copy of full warrant (including responsibilities and powers)

How many years have you been an inspector at your current territorial authority?

How many years have you been an inspector over all your career?

Name of inspector 4

Job title

Phone number

Email

Is this the Chief Licensing Inspector?

YES

NO

First time registering as a member?

YES

NO

If YES > Attach a copy of full warrant (including responsibilities and powers)

How many years have you been an inspector at your current territorial authority?

How many years have you been an inspector over all your career?

Name of inspector 5

Job title

Phone number

Email

Is this the Chief Licensing Inspector?

YES

NO

First time registering as a member?

YES

NO

If YES > Attach a copy of full warrant (including responsibilities and powers)

How many years have you been an inspector at your current territorial authority?

How many years have you been an inspector over all your career?

Name of inspector 6

Job title

Phone number

Email

Is this the Chief Licensing Inspector?

YES

NO

First time registering as a member?

YES

NO

If YES > Attach a copy of full warrant (including responsibilities and powers)

How many years have you been an inspector at your current territorial authority?

How many years have you been an inspector over all your career?

Name of inspector 7

Job title

Phone number

Email

Is this the Chief Licensing Inspector?

YES

NO

First time registering as a member?

YES

NO

If YES > Attach a copy of full warrant (including responsibilities and powers)

How many years have you been an inspector at your current territorial authority?

How many years have you been an inspector over all your career?

Name of inspector 8

Job title

Phone number

Email

Is this the Chief Licensing Inspector?

YES

NO

First time registering as a member?

YES

NO

If YES > Attach a copy of full warrant (including responsibilities and powers)

How many years have you been an inspector at your current territorial authority?

How many years have you been an inspector over all your career?

Name of inspector 9

Job title

Phone number

Email

Is this the Chief Licensing Inspector?

YES

NO

First time registering as a member?

YES

NO

If YES > Attach a copy of full warrant (including responsibilities and powers)

How many years have you been an inspector at your current territorial authority?

How many years have you been an inspector over all your career?

Name of inspector 10

Job title

Phone number

Email

Is this the Chief Licensing Inspector?

YES

NO

First time registering as a member?

YES

NO

If YES > Attach a copy of full warrant (including responsibilities and powers)

How many years have you been an inspector at your current territorial authority?

How many years have you been an inspector over all your career?

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