UniForum NZ '98 Printable Registration Form

UniForum NZ '98        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 accompanied by payment.
MAIL To: UniForum NZ '98, PO Box 585, Hamilton or
FAX: +64 7 839 2084 (Credit card payments only).
DELEGATE
Title: Mr, Ms, Mrs, Miss, Dr _________  Company: ______________________________
Surname: _____________________________  Postal Address: _______________________
Initials: ____________________________    _____________________________________
Preferred Name: ______________________  Email: ________________________________
Phone: _______________________________  Fax: __________________________________
Special Needs: _______________________  Position in Company: __________________
Student declaration: I am currently enrolled for a full time course of study at
(Institution)__________________________________ Signed:
Conference Fees             UniForum
                    NZ Member   Non-Member*
Conference and 2 days of tutorials+ $1245       $1345       $______
Conference and 1 day of tutorials+   $945       $1045       $______
Conference and one half day tutorial+    $845        $945       $______
Conference only              $645        $745       $______
Student (conference only)        $125        $170       $______
Full day tutorial only+          $450        $550       $______
Half day tutorial only+          $300        $400       $______
For registrations received on or before 14 April 2019:
Earlybird discount            $75-        $75-      $______
Only applies to full (not student) registrations.
South Island discount             $50-        $50-      $______
* Includes UniForum NZ membership fee for year ended 31/3/99
+ Please indicate tutorial session(s) below
Tutorial Sessions: Please mark to indicate which sessions you intend to attend
Tuesday 19 May 2019
     Tutl 1 [ ] Tutl 2 [ ] Tutl 3 [ ] Tutl 4 [ ] Tutl 5 [ ] (Tutl 6 cancelled)
Wednesday 20 May 2019
     Tutl 7 [ ] Tutl 8 [ ] Tutl 9 [ ] Tutl 10[ ] Tutl 11[ ]
ACCOMPANYING PERSONS/EXHIBITORS
Adults         $260 covers lunches and social events.
Children under 14   $75 covers lunches and Thursday dinner.
Children under 5   No charge
                Thursday Dinner only    Adult   $60
                Thursday Dinner only    Child   $30
                Conference Dinner only      $90
Surname     Preferred Name      Special Needs/Age of Child
____________    ______________________  _____________________________   $______
____________    ______________________  _____________________________   $______
____________    ______________________  _____________________________   $______
PAYMENT METHOD
By Cheque [ ]  Mastercard [ ]  Amex [ ]  Visa [ ]
                            TOTAL PAYMENT   $______
Card Number ___________________________ 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 (dates) ______________ to departure on _______________
 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.