REGISTRATION FOR PROCUREMENT OPTIONS WORKSHOP
2017 LOCAL GOVERNMENT INFRASTRUCTURE MANAGEMENT FORUM 26/27 April @ Rydges Wellington REGISTRATION FORM First name .............................................. Surname.................................................................. Position .................................................. ................................................................................ Organisation Name ................................ ................................................................................ Postal Address........................................................................................................................ ...............................................................
Business Phone ................................
Email Address........................................ ….. ………
Mobile................................................
Special dietary requirements or disabilities ............................................................................. REGISTRATION FEE IPWEA NZ GST No: 21 200 239
$535.00 + GST = $615.25
DINNER Deduct $75.00 (incl GST) if NOT attending
-- $
TOTAL PAYMENT
$_
PAYMENT OPTIONS □ Order No:......................................................., or □ Visa / MasterCard (2.5% surcharge applies) Cardholders Name:.................................................................................................................. Credit Card number:
Expiry date:………..…… CCV…….…..
Cardholders signature……………………….
Please send completed registration form: By Email to – [email protected] By Post to – IPWEA NZ, P O Box 25415, Wellington 6146 By Fax to – 07 867 7680 The Privacy Act 1993 requires 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 made available, please tick.
Business Phone ................................
Email Address........................................ ….. ………
Mobile................................................
Special dietary requirements or disabilities ............................................................................. REGISTRATION FEE IPWEA NZ GST No: 21 200 239
$535.00 + GST = $615.25
DINNER Deduct $75.00 (incl GST) if NOT attending
-- $
TOTAL PAYMENT
$_
PAYMENT OPTIONS □ Order No:......................................................., or □ Visa / MasterCard (2.5% surcharge applies) Cardholders Name:.................................................................................................................. Credit Card number:
Expiry date:………..…… CCV…….…..
Cardholders signature……………………….
Please send completed registration form: By Email to – [email protected] By Post to – IPWEA NZ, P O Box 25415, Wellington 6146 By Fax to – 07 867 7680 The Privacy Act 1993 requires 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 made available, please tick.
