PERSONAL DETAILS *Demotes MANDATORY this information must be completed if registration is to be completed – Date (day/month/year) * Mr Mrs Ms Miss Doctor First Name * Middle Name(s) Last Name * Gender * Male Female Ethnicity NZ European NZ Maori Other European Define: Pacific Peoples Define: Asian Define: Middle Eastern Define: American Define: African Define: Other Define: CONTACT DETAILS When completing this section, please ensure that you provide the best details to easily contact you. *Demotes MANDATORY field this information must be completed if registration is to be completed – Contact Details Phone Home – numbers * Work Work mobile Personal mobile Contact Details Email Personal – Address * Alternative Personal Work Contact Details Address * Number and Street – Suburb City Postcode
PERSONAL DETAILS *Demotes MANDATORY – this information must be completed if registration is to be completed Date (day/month/year) * Mr Mrs Ms Miss Doctor First Name * Middle Name(s) Last Name * Gender * Male Female Ethnicity NZ European NZ Maori Other European Define: Pacific Peoples Define: Asian Define: Middle Eastern Define: American Define: African Define: Other Define: CONTACT DETAILS When completing this section, please ensure that you provide the best details to easily contact you. *Demotes MANDATORY field – this information must be completed if registration is to be completed Contact Details – Phone numbers * Home Work Work mobile Personal mobile Contact Details – Email Address * Personal Alternative Personal Work Contact Details – Address * Number and Street Suburb City Postcode
nzmat-registration-of-interest-form-jan15.docx