ALGIM Corporate Membership Application
All details, including benefits and pricing, can be found at www.algim.org.nz/corporate
Application details
Please provide the details of the contact person for your organisation
Name
*
First Name
Last Name
Job title
*
Organisation
*
Organisation's tag line
*
0/255
Email
*
example@example.com
Preferred phone number
*
-
Area Code
Phone Number
Alternative phone number
-
Area Code
Phone Number
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Organisation website URL
*
Please upload your organisation logo
*
Browse Files
Maximum file size 100 MB
Cancel
of
Payment
ALGIM will invoice your organisation using the details you provided. If you use purchase order numbers, please enter it below.
Purchase order number
Additional information/enquiries
All information provided in this form is correct and accurate, and I agree that the organisation/company I represent can be invoiced by ALGIM for the associated costs.
*
I agree
Submit
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