Application Form
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Please make your application by filling out this form and printing or faxing it to:
Cement & Concrete Association of New Zealand, PO Box 448, Wellington, New Zealand.
Fax (+64-4) 499 7760.  
Title
Contact Name:
Organisation: 
Postal Address: 
Street Address:
Telephone:
Fax:
E-mail:
Type of Business: 
 
Type of Membership: (NZ incl. GST)
Gold (Corporate) $ 630
Silver (Medium sized organisations - 15-50 staff)  $ 250
Bronze (Small organisations >15 staff or individual)  $ 90
Student (Must show evidence of student ID)  $ 40

Payment:


Cheque    Visa     Mastercard

Card No:
Name on Card: 
Expiry Date: