UniForum NZ '96
REGISTRATION FORM

TAX INVOICE GST No. 12-523-987

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 accompanied by payment.
MAIL TO: UniForum NZ '96,
PO Box 585, Hamilton
or FAX: +64 7 839 2084
(Credit card payments only).
DELEGATE
Title: Mr, Ms, Mrs, Miss, DrCompany:
Surname:Postal Address:
Initials:
Preferred Name:
Phone:Fax:
Email:Position in Company:
Special Needs:
Student declaration: I am currently enrolled for a full time course of study at
(institution)Signed:
Conference Fees UniForum NZ MemberNon-Member*
Conference and 2 days of tutorials
(please specify sessions below)
$1195$1295$
Conference and 1 day of tutorials
(please specify sessions below)
$895$995$
Conference and one half day tutorial
(please specify session below)
$795$895$
Conference only$595$695$
Student (conference only)$55$100$
Full day tutorial only
(please specify session below)
$400$500$
Half day tutorial only
(please specify session below)
$250$350$
* Includes UniForum NZ membership fee for year ended 31/3/97
Earlybird discount for registrations received on or before 19 April 2019 $75$75- $
Only applies to full (not student) registrations.
Tutorial Sessions: Please tick to indicate which sessions you intend to attend
Tuesday 21 May 2019 Tutorial 1 [ ]Tutorial 2 [ ]Tutorial 3 [ ]Tutorial 4 [ ]Tutorial 5 [ ]
Wednesday 22 May 2019 Tutorial 6 [ ]Tutorial 7 [ ]Tutorial 8 [ ]Tutorial 9 [ ]
ACCOMPANYING PERSONS/EXHIBITORS
Adults$230 covers all meals and social eventsThursday Dinner only Adult $60
Children under 14$75 covers lunches and Thursday dinner Child $30
Children under 5No chargeConference Dinner only $90
SurnamePreferred NameSpecial Needs / Age of Child
$
$
$
Please includeAdults andChildren on the tour of Rotorua
PAYMENT METHOD
By Cheque [ ]Mastercard [ ]Amex [ ]Diners Club [ ]Visa [ ] TOTAL PAYMENT $
Card NumberExpiry Date
Card NameSignature
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 (date)to departure on
Special Requirements
If sharing accommodation with another delegate, please detail here:
NameCompany
OFFICE USE ONLY Registration number:Credit Card Authorisation: