

	Kayaking Beagle Channel Jim Hepburn

Payments (Step 1 of 2):

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Payments (Step 1 of 2):

Please complete and submit the following form.

Tick (select) a listed payment item that you wish to pay AND/OR;
Tick (select) "Other Payment Item", enter in the dollar value amount and a brief payment description.

You will then be taken through to a summary page and will be required to enter your Credit Card Details.

Required fields are indicated by a #.

# First Name:

# Surname:

# E-mail Address:

# Address 1:

Address 2:

# City:

# Country:

Member Number:

Member Website Password:

**Required & Verified if provided.

# Payment Items:

Please tick the item(s) that you are paying for. If entering an "Other Payment Item", please tick, enter in the dollar amount and a brief description of the item.
Payment Items:
	$100.00	� NZOIA Assessment Deposit ~ please enter details in comments box - below
	$50.00	� NZOIA Award Reassessment Administration Fee
	$130.00	Membership Renewal - Full Registered Member, with 1 NZOIA Award
	$160.00	Membership Renewal - Full Registered Member, with 2 NZOIA Awards
	$190.00	Membership Renewal - Full Registered Member, with 3 NZOIA Awards
	$80.00	Membership Renewal - Full Registered STUDENT Member, with 1 NZOIA Award
	$110.00	Membership Renewal - Full Registered STUDENT Member, with 2 NZOIA Awards
	$140.00	Membership Renewal - Full Registered STUDENT Member, with 3 NZOIA Awards
	$50.00	Membership Renewal - ASSOCIATE (Non-award holder only).
	$30.00	� NZOIA Award Registration Fee - 1 award.
	$20.00	� Award Certificate - replacement of original certificate.
Other Payment Item - please enter details:
Item	Cost	Payment Description
	$

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