Te ORA Membership Online Application

Please Note:

We will email you regular newsletters and items of interest.
We may contact you from time to time to ask for your input on matters relevant to Maori health and the Maori medical workforce.
The information you give on this form will provide us with statistical data on the Maori medical workforce.
We will not give out your personal details to third parties without your permission.

Personal Details
Title Dr Ms Mr Mrs Miss Other
First Name
Last Name
Gender Male Female
Iwi affiliation/s
Email
Telephone
Postal Address
Line 1
Line 2
Suburb
City
Postcode
University Information
Name of University
Year Enrolled (yyyy)
Year Graduated (yyyy)
Degree(s) Enrolled
Degree(s) Obtained
College Qualifications
Please list any college qualifications you hold:
Specialist Information
Are you in training to become a Medical Specialist?
Yes No
Employment Information
Position held
Specialty
Current place of Work
Special Interests
Are you a Fellow of a Medical College?
Yes No

Payment Details

Please select a membership type.




Credit/Debit Card
Cheque
Enter the letters you see
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