ASMS and TEU Join Form

University workplace
Which University are you employed with?(Required)

Auckland University

Otago University
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Department(Required)
University commencement date(Required)
Day
Month
Year
Weekly University Hours(Required)
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Date Joined
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Position(Required)
Current Position(Required)

Permanent

Fixed term

Casual

Te Whatu Ora Workplace
Hospital Employer(Required)
You have selected Health New Zealand as your employer, if you work for a Te Whatu Ora district eg Taranaki, please go back and select your district
Te Whatu Ora - Te Toka Tumai Auckland Workplace(Required)
Te Whatu Ora - Hauora A Toi Bay of Plenty Workplace(Required)
Te Whatu Ora - Waitaha Canterbury Workplace(Required)
Te Whatu Ora - Te Matau a Māui Hawke's Bay Workplace(Required)
Te Whatu Ora - Capital, Coast & Hutt Valley Workplace(Required)
Te Whatu Ora - Lakes Workplace(Required)
Te Whatu Ora - Te Pae Hauora o Ruahine o Tararua MidCentral Workplace(Required)
Te Whatu Ora - Nelson Marlborough Workplace(Required)
Te Whatu Ora - Te Tai Tokerau (Northland) Workplace(Required)
Te Whatu Ora - Counties Manukau Workplace(Required)
Te Whatu Ora - Taranaki Workplace(Required)
Te Whatu Ora - Tairawhiti Workplace(Required)
Te Whatu Ora - South Canterbury Workplace(Required)
Te Whatu Ora - Southern Workplace(Required)
Te Whatu Ora - Waikato Workplace(Required)
Te Whatu Ora - Wairarapa Workplace(Required)
Te Whatu Ora - Waitematā Workplace(Required)
Te Whatu Ora - Whangnaui Workplace(Required)
Te Whatu Ora - Te Tai o Putini West Coast Workplace(Required)
Department(Required)
Hospital Workplace Address(Required)
Street Address Address Line 2 City ZIP / Postal Code Country

Weekly Te Whatu Ora Hours(Required)
Te Whatu Ora commencement date(Required)
Day
Month
Year

Subscription
Subscription are $1,200.00 per annum (pro rata for partial year). Our financial year ends on 31 March. Reduced subscriptions are available for members who earn less than $120,000 per annum. In these cases the subscription is calculated at 1% of the salaried earnings, the minimum being $100.00.
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Authorisation(Required)
I authorise ASMS to collect fees on behalf of TEU and share this information with TEU.

DO YOU AGREE TO THE ABOVE?
Yes, I agree
Authorisation(Required)
In accordance with TEU policy, I agree that the TEU is not obliged to act on my behalf in any matter that arose prior to this application.

DO YOU AGREE TO THE ABOVE?
Yes, I agree
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ASMS/TEU MEMBERSHIP FORM

PERSONAL INFORMATION

University workplace

Te Whatu Ora Workplace

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