Student Membership Renewal

Name (required)

Gender

What is your date of birth

What is your postal address (required)

Home Phone (required)

Email Address (required)

Ethnic Origin

If you are of Maori descent, please supply details of your Iwi and Rohe

Which course are you enrolled in (required)

Which University are you enrolled at (required)

What is your expected date of graduation (required)?

I agree to abide by the Rules of the College (required)
---TrueFalse

In the past 12 months I have not had a complaint laid against me with the Psychologists Board, or equivalent overseas body, the Health and Disability Commissioners, or part of the judicial system, in relation to my professional conduct (required)
---TrueFalse

If there is such a complaint I agree to provide to the President or his/her nominee of the College brief details and give permission for the release of any records pertaining to complaints made to, or actions taken by, the above authorities (required)
---YesNo

I wish to renew my MPS membership (required)
---YesNo

Please attach evidence of enrolment (required)

When you click submit, you will be sent an email confirming your student membership renewal