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Application to notify change of address or join NZSA Fields denoted * must be filled; default settings are for change of address   Title: Surname or Family Name:* First or Given Name:* Address (for posting journal):*       Country: Phone:* Fax: Email:* Permission to publish:     Contact Details in Australia & NZ Members Directory? Yes No     Name, Address, Phone, Fax in Web Directory? Yes No     Email Address in Web Directory? Yes No Occupation: Gender: Male Female (for statistical purposes!) Year of Birth: Employer: Areas of Interest: eg, Experimental Design, Time Series, Stochastic Processes, Official Statistics, etc   Please choose membership category from drop-down list. Make cheques out to NZ Statistical Association. (NZSA is not registered for GST.) Membership type:* Choose from drop-down menu Ordinary Member NZ: $80 Ordinary Member Overseas: $85 Student or Retired NZ: $40 Student or Retired Overseas: $45 Ordinary Member NZ (electronic journal only): $75 Ordinary Member Overseas (electronic journal only): $80 Student or Retired NZ (electronic journal only): $35 Student or Retired Overseas (electronic journal only): $40 SSAI member NZ: $50 SSAI member Overseas: $55 Student (New Member): $0 $ (NOTE: First year free for senior students at NZ universities or graduates of NZ universities studying overseas, and not in full-time employment) Donation to NZSA (tax-deductible if $5 or more)   $ Payment Details, in increasing order of cost to NZSA Please submit electronic form for all methods of payment. No payment required for change of address. Payment by automatic payment or telebank: Please ensure that your name will appear on our bank statement (e.g., Subs Mary Smith, Dunedin) Bank 02 Bank of New Zealand Branch 0500 BNZ Centre, Wellington Account 0019525-00 New Zealand Statistical Association Payment by cheque: Make out to New Zealand Statistical Association (Inc). Payment by Mastercard or Visa: Please supply this information Credit Card number Cardholder's name Expiry date Amount: $NZ The NZSA Email address and Website are not secured sites so confidentiality of credit card email transmission cannot be guaranteed. If paying by credit card, fax or mail hard copy. Signature:   Date: Fax to Harold Henderson +64 (7) 838 5012 or Post to Harold Henderson, Statistics, AgResearch Ruakura, Private Bag 3123, Hamilton, NZ For more information contact Harold Henderson