General Registration Application Subscription Personal Info - Optometrists and Dispensing Opticians Board New Zealand

Personal Information
Contact Information

Title

Please select your title from the drop-down list in the designated field. This will help us address you appropriately and ensure accurate communication.

Preferred pronoun

Please share your preferred pronouns (e.g., he/him, she/her, they/them) to help us communicate with you respectfully. Your input is valued and ensures we address you appropriately.

First Name *

Middle Name

Last Name *

Preferred Name

Date of Birth *

Gender *

Ethnicity 1 *

Ethnicity 2

Ethnicity 3

All registered practitioners must provide the Optometrists and Dispensing Opticians Board (ODOB) with current contact details. You must update your details promptly if there is any change of your contact information, including postal and email addresses.

Please update any changes below.

Communication

The ODOB communicates important information with all registered practitioners. This includes practising certificate reminders and CPD specific communication, important notices or newsletters. If you wish to receive this, please tick that you agree below.

Do you wish to receive SMS alerts and notifications from the ODOB?

Yes

Do you wish to receive emails from the ODOB? *

Yes

Email *

Mobile Phone *

Mobile number should be: (+6421 122 333) OR (E.g. +6421 122 333)

I have read and agree to the ODOB's Privacy Statement

Yes

Address Information

Home

Home Address

Address Line 1

Address Line 2

City

Country

Province/State

Postal/Zip

Mailing

Mailing Address

Address Line 1

Address Line 2

City

Country

Province/State

Postal/Zip

Work

Employer

Work Address

Address Line 1

Address Line 2

City

Country

Province/State

Postal/Zip

Publish Work Address

Yes

Please be sure to open each of the tabs to update/review your information