Organisational Membership Form – The Sustainability Society

Please complete the following form

The Sustainability Society: Application for Organisational Membership

Organisation name*
Address*
Street Address Address Line 2 City ZIP / Postal Code Country
Phone
Type of organisation and objectives*
Please briefly state the type of organisation and its objectives
Organisational Representatives As part of your membership you can nominate three of your team as TSS members to represent your organisation and receive direct member benefits. Please fill out their details below.
Representative One: Name*
First Last
Title*
- Mr
- Miss
- Ms
- Mrs
- Dr
- Prof
Role*
Phone*
Email*
Address (if different from organisational address above)
Street Address Address Line 2 City ZIP / Postal Code Country
Specific areas of interest
Date of birth*

Day
Month
Year

For office purposes only
Are you an existing member of Engineering New Zealand (IPENZ)?*
- Yes
- No
Representative Two: Name
First Last
Title
- Mr
- Miss
- Ms
- Mrs
- Dr
- Prof
Role
Phone
Email
Address (if different from above)
Street Address Address Line 2 City ZIP / Postal Code Country
Specific areas of interest
Date of birth

Day
Month
Year

For office purposes only
Are you an existing member of Engineering New Zealand (IPENZ)?
- Yes
- No
Representative Three: Name
First Last
Title
- Mr
- Miss
- Ms
- Mrs
- Dr
- Prof
Role
Phone
Email
Address (if different from above)
Street Address Address Line 2 City ZIP / Postal Code Country
Specific areas of interest
Date of birth

Day
Month
Year

For office purposes only
Are you an existing member of Engineering New Zealand (IPENZ)?
- Yes
- No
Primary Organisational Contact*

Please identify which of your Organisational Representatives will be listed as the primary contact for the Organisation (this person will also receive communication regarding annual fees and be responsible for making any changes to those listed as Organisational Representatives).
Primary Organisational Contact Email*
Membership fees The Sustainability Society ANNUAL MEMBERSHIP FEES (Year ends 30 September 2022) Organisational Member: $750 plus GST You will be contacted in due course regarding the payment of fees.
Declaration*
- I agree
In applying for membership of The Sustainability Society Technical Interest Group, I, as a nominated Representative of my Organisation, hereby agree that, in the event of my Organisation’s admission, it will be governed by the rules of the Group for the time being in force or, as they may hereafter be amended.