Agent Membership
(Incl GST)

Please fill out the following registration information:
  • (One only for Agent, Individual or Supplier/Partner Membership)
  • (Corporate or Platinum Membership only)
  • (Corporate or Platinum Membership only)
  • Brief explanation of business activities
  • Practitioner/Vendor/Vendor & Practitioner/Other - please specify
  • Please Categorise
    I acknowledge and give permission for CCiNZ to publish for marketing purposes photo’s/content with your name/organisation
  • Pay by Invoice if joining outside membership year

    Membership year commences 30th June so please select
  • How would you like to pay?