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Our World, New

Horizons
REGISTRATION FORM 2016
Registration is due by Tuesday 5 April 2016
Registration Fee: $75.00
Conference fee includes: morning tea, afternoon tea and lunches

DELEGATE DETAILS
Please fill in one Registration form for each delegate
Name

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Surname

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Institute/Polytechnic

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Date of birth

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Email address

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Telephone(Work)

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City/ Suburb

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Yes

Vegetarian

Yes

Attending Conference Dinner?


Accessibility requirements please list

No

No

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Estimated time arrival information


(optional, if known)

Date:

Time:

Estimated time departure information


(optional, if know)

Date:

Time:

Registration details:

Payment Details:

Please complete the registration form


and email (as an attachment) to:
Tania.wharry@boppoly.ac.nz

Online payments: NBAF Account


Bank Account: 12 3143 0158079 00

Alternatively post to:


Bay of Plenty Polytechnic
Private Bag 12001
Tauranga 3030
Attention : Tania Wharry
325567176

Manual Payments to:


T Wharry
NBAF Treasurer
C/- BOPP
Private Bag 12001
Tauranga 3030

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