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| Surname: |
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| Given Names |
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| Postal Address: |
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| Street Address: |
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| Email: |
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| Tel: |
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| Fax: |
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| Mobile: |
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No of years experience
in building design? |
Years |
Experience
(Please provide details) |
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Educational Qualifications
Held: |
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| Assessment level Required: |
Probationary |
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Colleague |
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Technician |
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Membership of other
related organisations: |
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Date present practice
commenced: |
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Brief description of
work carried out: |
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| Form of Business: |
SoleTrader |
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Partnership |
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Associate |
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Limited Liability Company |
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Shareholder Employee |
| Name of Practice Partners: |
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| Do you employ Staff? |
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| Number of Staff & Positions: |
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Do you have professional
indemnity cover? |
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| (If yes) Please provide details: |
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| Insurer: |
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| Cover: |
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| Excess: |
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| Premium: |
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Are you currently getting
quotes for cover? |
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I hereby apply for membership
of ADNZ and assessment for
competency as an architectural
designer. I certify that the information
above is true and correct. I agree
by the Rules and Code of Ethics
of Architectural Designers
New Zealand Inc. |
I agree
I disagree |
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All detials provided by members
upon joiing ADNZ are collected
for the purpose of ADNZ Inc
records. Details of members'
names and practise address
are provided to sponsors and
other National Executive
approved organisations |
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If you do not wish this infoation
to be provided, Please tick here: |
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| Any comments? |
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