ASMS/TEU MEMBERSHIP FORM

ASMS will represent members for individual and departmental matters arising in your work, any secondment or purchase of your time by Te Whatu Ora.

TEU will represent members in all matters relating to your university employment.

Joint membership is for senior doctors and dentists who are formally employed solely by a university but who work at a public hospital as part of that contract, due to some sort of buy back arrangement with the university.

Joint membership is not for members who have a direct employment contract with Te Whatu Ora (in addition to the university employment contract).

1Personal Information

2University workplace

3Te Whatu Ora workplace

4Subscription

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

Auckland University

Otago University
Campus(Required)
Department(Required)
University commencement date(Required)
Day
Month
Year
Weekly University Hours(Required)
This field is hidden when viewing the form
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(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.
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
CAPTCHA

ASMS/TEU MEMBERSHIP FORM

PERSONAL INFORMATION

University workplace

Te Whatu Ora Workplace

Subscription