2012 Registration

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					                            inFIRE 2012 Conference 2012
                            Registration Form
                            Recover. Revive. Reach.

An invoice and confirmation of your registration will be emailed to you within 14 days of receiving your completed registration form. The
invoice will include all payment details.
Please make the invoice out in (please circle): My name / My Organisation’s name / Other

PERSONAL INFORMATION

Title     Choose an item.        Surname                                               First Name

Name to be displayed on Name Tag

Organisation/Company                                                       Employment Position

Mailing Address

Post Code                      Country                                           Telephone

Email                                                                            Fax


        I would like my name, address and details EXCLUDED FROM the list of delegates.

REGISTRATION FEES
An invoice and confirmation of your registration will be emailed to you within 14 days of receiving your completed registration
form. The invoice will include all payment details.
Please make the invoice out in (please circle): My name / My Organisation’s name / Other
Full registration received before 5 February 2012 is $360.00 (NZ) and $420.00 (NZ) after 5 February 2012. Day registration received before
5 February 2012 is $120.00 (NZ) per day, and $150.00 (NZ) per day after 5 February 2012. Registration includes New Zealand Goods and
Services Tax.
        Full Registration* $360.00 (NZ) / $420.00 (NZ)
        Single Day Registration** $120.00 (NZ) per day / $150.00 (NZ) per day
            Please indicate day(s) you will be attending:   Tuesday   Wednesday        Thursday      Friday
*Full registration includes conference sessions, breaks, lunches, conference dinner, and transportation for off-site events.
**Day registration includes that day’s sessions, breaks and lunch, and transportation to off-site events if applicable.
                                                                                                  Registration Sub-total
GUESTS AT CONFERENCE DINNER
Guests are welcome for the Wednesday Evening Conference Dinner. The cost is $70.00 (NZ) per guest.
Number of guests for conference dinner                      x $75.00 per guest                    Guest Sub-total

SPECIAL REQUIREMENTS
Diet/Allergies                                                        Medical/Wheelchair


SUBMIT YOUR REGISTRATION TO: APRIL FLUX
By email:             april.flux@fire.org.nz                           By fax:              +64 4 496 3700
By mail:              New Zealand Fire Service, PO Box 2133, Wellington 6140, NEW ZEALAND

				
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