ACHIEVE MEMBERSHIP FORM
FOR FINANCIAL YEAR:
January 2008 - December 2008

The National Post-Secondary Education Disability Network,
New Zealand (Inc)
GST Number: 63-486-523

Members Name and Address Details
Organisation Name:	_________________________________________________________________
Job Title*	_________________________________________________________________
Name:	_________________________________________________________________
Address:	_________________________________________________________________
	_________________________________________________________________
Phone:	_________________________________________________________________
Fax:	_________________________________________________________________
Email:*	_________________________________________________________________
Please indicate:	New Subscription	Renewal	Invoice Required

Community-Based Organisations (Number of paid staff)
1-25 $50.00	26-50 $100.00	51+ $150.00
Non paid staff $25.00
Post-Secondary Education Institutions (Number of EFTS)
$150 per 5,000 EFTS (Minimum $150; round up to nearest 5,000)
Number of EFTS ..................
Student Associations
Student Unions $25.00	Action Groups $20.00
Individual membership
Unwaged or Student $10.00		Waged or Family $20.00

Are materials required in:

Large Print

Disk

Electronic copy