Please note that the signed Declaration must be returned to Education New Zealand within one (1) week of attending the Training Day.   Please send to agents@educationz.org.nz

I declare that   *______________________________ understands and agrees to abide by the NZSA Agreement, including the stated advertising and publicity policy; and authorise Education New Zealand to carry out such reference checks as may be necessary to confirm eligibility of my Agent for NZSA membership.  (* = Agent name)

Authorised Signatory:                     __________________________


Authorised Signatory Name:          __________________________


Position within Agent:                   __________________________


Date:                                             ____________


Nominated Contact Person:         __________________________


Nominated Contact Person e-mail:       ________________________


Agency Website address:    

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Agent Physical Address (if different):    

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