z_FPIA Conference

Registration Form

Friday 23rd of March 2001

Your Details:

Title: 
First Name: (for badge) 
Family Name: 
Company Name: 
Postal Address:  
City: 
Business Phone: 
Home Phone:  
Business Fax:  
Mobile Phone:  
Email Address: 
Special dietary requirements or disabilities:
 

Accompanying Partner:

First Name: (for badge) 
Family Name:
Hamner Akaroa Cruise

Accommodation:

Ist Choice:
 2nd Choice:
Room Type: Please tick the appropriate box
Double (queen bed) Twin (2 beds)
Other (please specify)
Arrival Date:
Departune Date:
Total Nights:
Special requirements:
be attending the Association breakfast on Friday, 20 July

Payment Details:

Card Type: Mastercard Visa
Cardholders Name:
Card Number:
Expiry Date:

The Privacy Act 1993 require that, before your name and address details can be published in the list of delegates either for distribution to fellow delegates or any other party, you must give your consent.

If you DO NOT wish your name and details to be included in the list of delegates please tick


Comments (0)
Comments to GoodReturns.co.nz go through an approval process. Comments which are defamatory, abusive or in some way deemed inappropriate will not be approved.