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General: ask@nzrda.org.nz
Membership: membership@nzrda.org.nz
Phone: 0800 803 993
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Membership Form
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*
" indicates required fields
Purpose
*
I would like to join NZRDA for the first time
I have been a member before and would like to rejoin
I would like to renew my membership and pay my fees
I would just like to update my details
------------------------------------QUESTIONS IF REJOING/RENEWING/UPDATING----------------------------------------
Which details would you like to update?
*
Personal Details
Employment Details
Since my last membership renewal:
*
My personal details may need to be updated - (address, mobile, etc)
My employment details may need to be updated - (run, designation etc)
My personal and employment details have not changed
I am choosing to rejoin because:
*
- Select -
I'm returning from overseas
I'm re-joining the medical workforce
I'm leaving an alternative Union
I have a different reason (please elaborate below)
Other reason for rejoining:
*
Membership Number
Designation
*
- Select -
House Officer
SHO
Registrar
Fellow
Trainee Intern
Clinical Student
1st Year Public Health Registrar (NZCPHM)
Employer
*
- Select -
Te Whatu Ora
RNZCGP
University of Otago
Private
NZCPHM
Employer
*
- Select -
Te Whatu Ora
University of Otago
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Employer if designation Trainee Intern
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Employer if designation Clinical Student
Specialty
*
- Select -
Anaesthetics
CBA - A&M Clinic
CBA - GP Placement
CBA - Hospice Placement
CBA - Integrated
CBA - Other Placement
Community Health
CTSU
DCCM
Dental
ED
Funding & Planning
Gen Surgery
Genetics
GP Rotation
ICU
ICU: Anaes Trainee
ICU: ED Trainee
ICU: Med Trainee
Locum
Maxillo-Facial
Medicine
Medicine: Assessment
Medicine: AT&R
Medicine: Cardiology
Medicine: CCU
Medicine: Dermatology
Medicine: Diabetes
Medicine: Endocrinology
Medicine: Gastroenterology
Medicine: Haematology
Medicine: Immunology
Medicine: Inf Diseases
Medicine: Nephrology
Medicine: Neurology
Medicine: O&G
Medicine: Pharmacology
Medicine: Relief
Medicine: Renal
Medicine: Respiratory
Medicine: Rheumatology
Medicine: Stroke
MSC
Neurosurgery
O & G
Oncology
Oncology: Medical
Oncology: Radiation
Ophthalmology
ORL
Orthopaedics
Ortho-Trauma
Paed: Ambulatory
Paed: Cardiology
Paed: CED
Paed: CFU
Paed: ED
Paed: Endo/ID
Paed: ENT
Paed: Gastroenterology
Paed: General
Paed: Med
Paed: Neonates
Paed: Neuro Disability
Paed: Neurosurgery
Paed: NICU
Paed: Oncology
Paed: Ortho
Paed: PICU
Paed: Psych
Paed: Relief
Paed: Renal
Paed: Resp
Paed: Surg
Paediatrics
Palliative Care
Parental Leave
Path: Chemistry
Path: Forensic
Path: Genetics
Path: Haemotology
Path: Histology
Path: Microbiology
Path: Virology
Pathology
Pharmacology
Plastics
Psychiatry
Public Health
Radiology
Relief
RHM
Sexual Health
Spinal
Supernumerary
Surgery Reliever
Surgery: Fellow
TBA
Transplant
Unpaid Leave
Urology
Vascular Surgery
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Specialty
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Specialty
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Region
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Region
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Region
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Region
Location
*
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Northland
Auckland
Waitemata
Counties Manukau
Waikato
Bay of Plenty
Lakes
Taranaki
Tairāwhiti
Hawke’s Bay
MidCentral
Whanganui
Wairarapa
Capital & Coast
Hutt Valley
Nelson Marlborough
Canterbury
South Canterbury
West Coast
Southern
Location
*
University of Otago
University of Auckland
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-------------------Workplace (if Te Whatu Ora)--------------------------------------------------
Workplace Northland
*
- Select -
CBA
Whangarei
Workplace Auckland
*
- Select -
Auckland
CBA
Central
Greenlane
Manawanui Oranga Hinengaro
Starship
Workplace Waitematā
*
- Select -
CBA
North Shore
North West
Waitākere
Workplace Manukau
*
- Select -
CBA
Manukau Superclinic
Middlemore
South
Workplace Waikato
*
- Select -
CBA
Thames
Waikato
Workplace Bay of Plenty
*
- Select -
CBA
Tauranga
Whakatāne
Workplace Lakes
*
- Select -
Rotorua
CBA
Workplace Taranaki
*
- Select -
CBA
Taranaki
Workplace Tairāwhiti
*
- Select -
CBA
Gisborne
Workplace Hawke's Bay
*
- Select -
CBA
Hastings
Workplace Midcentral
*
- Select -
CBA
Palmerston North
Workplace Whanganui
*
- Select -
CBA
Whanganui
Workplace Wairarapa
*
- Select -
CBA
Masterton
Workplace Capital & Coast
*
- Select -
CBA
Kenepuru
Porirua
Wellington
Workplace Hutt Valley
*
- Select -
CBA
Hutt
Workplace Nelson Malborough
*
- Select -
CBA
Nelson
Wairau
Workplace Canterbury
*
- Select -
Ashburton
Burwood
CBA
Christchurch
Christchurch Women's Hospital
Workplace South Canterbury
*
- Select -
CBA
Timaru
Workplace West Coast
*
- Select -
CBA
Grey
Workplace Southern
*
- Select -
Oamaru
Dunedin
Dunstan
CBA
Lakes District
Southland
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Untitled
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profession_if_employer_NZCPHM or private or RNZCGP
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profession_if_employer_TWO or UoO
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profession_if_designation TI
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profession_if_designation Clinical Student
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professional title if_employer RNZCGP
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professional title if_designation_1st_Year_Public_Health_Registrar
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professional title if_designation_H/O
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professional title if_designation_SHO
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professional title if_designation_Trainee Intern
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professional title if_designation_Clinical Student
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professional title if_designation_Fellow
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professional title if_designation_Registrar
Professional Title
*
- Select -
GPEP
N/A
What is your expected basic training graduation date?
*
DD slash MM slash YYYY
Are you commencing work at a future date?
*
I am working now
I am yet to commence work
Future Work Commencement Date
*
YYYY dash MM dash DD
What year did you graduate?
*
What year clinical student are you?
*
- Select -
Year 1
Year 2
Year 3
Year 4
Year 5
Which medical school are you with?
Otago
Auckland
Where are you currently placed?
*
- Select -
Otago
Wellington
Christchurch
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Where are you currently placed?
*
CS - Auckland
When do you expect to commence work as a House Officer?
Medical Council Registration Number
Your Name
*
First*
Middle
Last*
Preferred / Alternative Name
Personal (non-work) Email
*
Mobile
*
Address
*
Street Address
Address Line 2
City
ZIP / Postal Code
Gender
*
*The Registrar of Unions requires us to collect this data
- Select -
Male
Female
Non Binary
My gender is not listed
Prefer not to answer
Which most closely describes your ethnicity?
*
You may select more than one
Prefer not to answer
Māori
Pasifika
Pākehā / European
Asian
Hispanic, Latino or Spanish Origin
Middle Eastern
African
My ethnicity is not listed
Consent
*
Each Member acknowledges that by virtue of their membership:
a. They appoint NZRDA to act as their exclusive agent in all matters connected with their employment or prospective employment, including the negotiation and enforcement of any individual or Collective Agreements unless agreed otherwise by the National Executive, provided that NZRDA can cease to act if the member and NZRDA agree.
b. They will be bound by the terms of any employment agreements which are negotiated by NZRDA and are duly ratified in accordance with these rules.
c. They will be bound by these rules until their membership ends, including rules relating to the procedure for the ratification of any terms of settlement of any negotiations relating to the terms and conditions of their employment to which NZRDA may agree pursuant to the Employment Relations Act 2000.
d. They give their consent to NZRDA accessing personal information relevant to their employment.
e. NZRDA’s appointment as their exclusive agent continues until their Membership ends, or on the member and NZRDA agreeing that the appointment should cease.
I have read, understood and accept the terms & conditions
Applicants who are yet to begin work
*
You indicated above that you are commencing work at a future date. If this date is more than one month from today, please submit this form without payment. We will then be in touch closer to your work start date to request payment. Thank you!
My work commencement date is less than one month from today
Signature
*
By writing your name below, you acknowledge you have read the terms above and give NZRDA the authority to act on your behalf:
Payment Type
*
Please select one
Pay Now Annual (Credit Card)
Pay Now Annual (Online Eftpos)
Monthly Automatic Payment
Name
This field is for validation purposes and should be left unchanged.