Affiliate Membership Application For Affiliate Membership Business DetailsBusiness Name(Required) Business Type(Required) Contact Name(Required) Contact Phone(Required) Reason for Joining HSPNZ(Required) Members Currently Joined HSPNZ(Required) Postal Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Region(Required)Please select which HSP(NZ) region you are within. Upper North Island Central North Island Lower North Island South Island Read Our Professional Membership Declaration Show More Text on Click Read Here Accuracy: The details set out in this Membership Form are true and correct. If they change the business acknowledges that it is required to notify HSP(NZ) Inc. of the changes in writing as soon as possible after they occur. If the details provided are not true or are misleading the business acknowledges its membership may be terminated at the discretion of HSP(NZ) Inc. Bound by Rules: I have read and the business will be bound by the constitutions, code of ethics, regulations, policies, manuals, guidelines and reasonable directions of HSP(NZ) Inc Privacy: The business agrees that HSP(NZ) Inc can obtain, hold, use and disclose my personal information as provided on this Form (and any updated or additional personal information HSP(NZ) Inc obtains from me including any photo or other record of my image) for the purposes of: Processing the business application for membership including notifying governing authorities we can bound to of the information on this form for the purposes of the HSP(NZ) Inc compiling a register of members, compiling a national database of members and participants (accessible only in accordance with the Constitution and Regulations HSP(NZ) Inc), and for requesting the business to renew if membership lapses; b. Putting the business name and contact information on HSP(NZ) Inc membership list for use by other members of HSP(NZ) Inc; Publishing any of approved information in HSP(NZ) Inc newsletters and on their websites; Providing the business with information and activities relating to HSP(NZ) Inc and other HSNO/HSWA matters; Including a photograph or other imagery on HSP(NZ) Inc website, in newsletters, annual reports, or similar official publications; Enabling HSP(NZ) Inc. to contact the business with information about the products and services of HSP(NZ) Inc. sponsors or funders (unless the business has opted out of receiving such information on the Membership Form); Enabling HSP(NZ) Inc to comply with any statute, regulation, by-law or other regulatory instrument that requires collection or disclosure of personal information; Retaining the information provided on this form if the business membership lapses (as an inactive member) for a maximum period of three years for the above purposes; and Any other purpose the business agrees to in writing. The business acknowledges that our business has not been under a professional investigation by an organisation for which we employ or contract to or a professional body such as Worksafe either in New Zealand or overseas. The Business has not been expelled or have been denied membership/approval to HSPNZ or any other Professional Organisation in the past. Agree and understand that HSP(NZ) Inc can obtain, hold, use and disclose my personal information as provided on this form for the benefit of obtaining membership support or approval from HSP(NZ) Inc. Use, Security and Access: I understand that our business information will only be used for the purposes of HSP(NZ) Inc. a. contact information will be held securely; b. the business will have access to contact information under the Privacy Act; c. the business information will be corrected upon request. d. Enabling HSP(NZ) Inc to obtain up to date approval information from Worksafe and EPA Use, Security and Access: I understand that my personal information will only be used for the purposes of HSP(NZ) Inc. Continued Membership: The business understands that upon payment of membership fee(s), if we are accepted to membership, the business will become a affiliate member of HSP(NZ) Inc and that by paying such fee(s) by the due date(s), I will continue to be a member of HSP(NZ) Inc for the duration of my Membership as specified on this form and in accordance with the HSP(NZ) Inc Constitution, unless we resign or the membership is terminated.