3456.                                                             THE NEW ZEALAND GAZETTE.                                                                 [No. 86

(2.) I entirely conducted cases of labour.
I desire to sit for examination as a midwife on [date], and enclose receipt for fee.

Signature of Applicant: . . . . . . . . . . . .

I certify the statements above as to training at to be correct.

Signature of Medical Officer: . . . . . . . . . . . .
Signature of Matron: . . . . . . . . . . . .

[Form No. 5.

APPLICATION FOR REGISTRATION UNDER NURSES AND MIDWIVES REGISTRATION ACT, 1925.

(a.) Any certificates forwarded with this application should be sent by registered post. They will be returned after they have been submitted to the Nurses and Midwives Registration Board.

(b.) This form should be completed as directed, and signed by the applicant and posted to the Secretary, Nurses and Midwives Registration Board, Health Department, Wellington.

Surname. Christian names.

1. What is your full name ?
2. What is your present address ?
3. Give the day, month, and year of your birth :

Application.

I hereby apply for registration as a { (1) Nurse.
(2) Midwife.
(3) Maternity Nurse.

(Strike out the words not applicable.)

(1.) This space to be completed by Applicants for Registration on Examination Qualifications.

I underwent years months training in [Give hospital or training-school] from to , and passed an examination as a [Nurse, maternity nurse, or midwife]. I attach copies of certificates, duly certified as correct copies by [Give name of medical practitioner, minister of religion, or Justice of the Peace certifying] in support of my claim for registration.

My place of abode is .
Dated at this day of , 192 .

(2.) This space to be completed by Applicants for Registration on account of previous Practice.

I have been regularly engaged in practice as a maternity nurse during the period from [Give dates] to , and enclose herewith a certificate to that effect, signed by [Give name of medical practitioner, minister of religion, or Justice of the Peace certifying].

My place of abode is .
Dated at this day of , 192 .

(Strike out (1) or (2), whichever does not apply).

Signature: . . . . . . . . . . . .

[Endorse.]

EXTRACT FROM NURSES AND MIDWIVES REGISTRATION ACT, 1925.

10. (1.) Save as provided in Part IV hereof, every person shall, on payment of the prescribed fee, be entitled to be registered as a nurse under this Part of this Act who satisfies the Board,—

(a.) In the case of an applicant trained in New Zealand—
(i.) That she has had not less than three years’ approved training as a nurse; and
(ii.) That she has received an approved course of instruction in theoretical and practical nursing; and
(iii.) That she has passed an examination for nurses under this Part of this Act :

(b.) In the case of an applicant trained elsewhere than in New Zealand, that she is the holder of a certificate, recognized in accordance with regulations under this Act, which satisfies the Board that she has undergone a course of training and has passed an examination equivalent to the training and examination required of nurses trained in New Zealand, as provided in the foregoing provisions of this section.