ASMS and TEU Join Form

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

Auckland University

Otago University
Campus(Required)
Department(Required)
University commencement date(Required)
Weekly University Hours(Required)
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Date Joined
DD slash MM slash YYYY

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
Street Address Address Line 2 City ZIP / Postal Code Country

Weekly Te Whatu Ora Hours(Required)

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.
Subscription
Subscription
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

Subscription