Practitioner Membership Subscription

An Assistive Technology Practitioner is defined as one or more of the following:

An Accredited Assessor under the Ministry of Health scheme
An ACC approved Assistive Technology assessor and/or provider
A member of a related professional body e.g. speech-language therapist, occupational therapist, teacher, psychologist working or seeking to work in Assistive Technology service provision.
Managers of services who are actively involved in the provision or development of direct services in Assistive Technology.

Username*

Password*

Retype Password *

First Name *

Last Name *

Email *

Phone or Mobile *

Profession / Position Held

Qualifications

Professional Membership or Registration No

MOH Accreditation

Assessor Number:

Payment by you or your employer? *

personally paying

employer paying

Organization *

Organization Address *

Organisation Address 2

Organisation City *

Organisation Post Code *

Organisation Order Number

Accounts Contact Name within Organisation *

Accounts Email Address within Organisation *

Home Address *

Home Address 2

Home City *

Home Post code *

Price

Tax Amount

Total Amount

Payment Method *

Internet Banking. An invoice will be sent to your nominated email address

Pay now with secure credit card processing through Payment Express

Credit Card Number*

Expiration Date*

Card (CVV) Code*

Card Holder Name*