UniForum NZ '99 	TAX INVOICE GST No. 12-523-987	      REGISTRATION FORM
Please complete one form per delegate, keep a copy of each for your records and
forward the originals, together with full payment of fees.  
Bookings will be made strictly in order of receipt of registration forms.
MAIL TO: UniForum NZ '99, PO Box 191, Hamilton,
or FAX: +64 7 839 2084 (Credit card payments only)
DELEGATE
Title: ________________________________ Company: _______________________________
Surname: ______________________________ Postal Address:  _______________________
Initials: _____________________________ ________________________________________
Preferred Name:  ______________________	Email Address: _________________________
Phone: ________________________________	Fax: ___________________________________
Special Needs:  _______________________	Job Title: _____________________________
Student Declaration: I am currently enrolled for a full time course of study at:
________________________________________________________________________________
___________________________(institution) Signed: _______________________________
Registration Fees (GST Inclusive) 		 UniForum    Non-
				      Student*	 NZ member   member*
Conference and two days of tutorials  $220       $1445       $1545  $ __________
Conference and one day of tutorials   $170	 $1095       $1195  $ __________
Conference and one half-day tutorial  $170	 $ 945	     $1045  $ __________
Conference only			      $120	 $ 645	     $ 745  $ __________
Full day tutorial only		      $ 50	 $ 550	     $ 650  $ __________
Half day tutorial only		      $ 50	 $ 350	     $ 450  $ __________
*Includes UniForum NZ membership fee for period ended 31 December 2019
For registrations received on or before 12th March:
Earlybird discount				-$  75	    -$  75  $ (________)
South Island discount				-$  50	    -$  50  $ (________)
Discounts apply only to non-student registrations
Tutorial Sessions - Please tick to indicate which sessions you intend to attend
Tuesday 13th April   Tutorial  1 [ ] Tutorial  2 [ ] Tutorial  3 [ ]
		     Tutorial  4 [ ] Tutorial  5 [ ] Tutorial  6 [ ]
Tuesday evening	   Free Tutorial [ ]
Wednesday 14th April Tutorial  7 [ ] Tutorial  8 [ ] Tutorial  9 [ ]
		     Tutorial 10 [ ] Tutorial 11 [ ] Tutorial 12 [ ]
ACCOMPANYING PERSONS / DINNER GUESTS
Adults		   $270 for conference lunches and all social events
		   $60 for Thursday dinner
		   $90 for conference dinner
Children under 14  $75 for conference lunches and Thursday dinner
		   $30 for Thursday dinner
Children under 5   No charge
Surname		     Preferred Name	Special Needs/Age of Child
__________________   __________________	___________________________ $ __________
__________________   __________________	___________________________ $ __________
__________________   __________________	___________________________ $ __________
PAYMENT METHOD
By:  Cheque [ ]  Mastercard [ ]  Amex [ ]  Visa  [ ]  TOTAL PAYMENT $ __________
Card Number: /_ _ _ _/_ _ _ _/_ _ _ _/_ _ _ _/   Card Expiry Date:  _ _ / _ _
Card Name: ___________________________________   Signature: ____________________
Billing Address (if different from above): _____________________________________
ACCOMMODATION No deposit required
Delegates are responsible for payment of accommodation and other hotel expenses
directly to the hotel.
From arrival on __________ day, ________________________ (date) to departure on
__________ day, _______________________ (date)  Room type: standard / SPA-Deluxe
Special requirements: __________________________________________________________
If sharing accommodation with another delegate, please detail here:
Name: _________________________	Company: _______________________________________
OFFICE USE ONLY Registration Number ________ Credit Card Authorisation _________


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Get Registration From via Email
You can get a copy of this registration form via email by sending a blank request to rego@uniforum.org.nz.