Forum 2012 Membership and Registration

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New Zealand School and Community Oral Health

Services Society
Membership and Forum Registration 2012
Forum details
Venue: Bayview Wairakei, Taupo
Dates: Wednesday 2nd May: Social gathering, 5.30 - 7.30pm
Thursday 3rd May: Forum 8.00 - 4.30pm, Dinner 6.30pm till late
Friday 4th May: Forum 8.00 -1.30pm (including lunch)
Membership $75.00
Registration

$250.00 (Member)

Registration

$350.00 (Non Member)

Registration

$200.00 (Day only)

Post to:
Pip Zammit
Oral Health Service Manager
Northland District Health
Board
Private Bag 9742
Whangarei 0148

Name: __________________________________________________
Address: ________________________________________________
________________________________________________________
________________________________________________________
Designation _____________________________________________
Organisation ____________________________________________
Phone: _________________________________________________
Cell phone: _____________________________________________
Email: _________________________________________________

Total amount enclosed: $

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