NZCA Annual AGM & CONFERENCE 2017 NZCA AGM and Conference - May 2017 Online booking form for the NZCA AGM and Seminar 2017In order for us to accurately organise and cater for this event could you please complete a separate form for each staff member attending. Step 1 of 3 33% Contact DetailsTitle*DrMrMrsMsName* First Last Address*Please enter your billing details. Street Address Address Line 2 City ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country Email* Home PhoneWork PhoneMobile Phone* Registration DetailsFull registration is inclusive of all catering and a banquet ticket. The member fee applies to members of the NZCA. Attendance at the AGM is for NZCA members only. Prices displayed are Earlybird prices - saving up to $100 on full fee and the Earlybird prices expire on 14/4/17. Title*DrMrMrsMsName First Last Attendance*Attending AGM onlyWill not be attending AGM please pass on an ApologyAttending AGM and ConferenceAttending Conference onlyRegistration DetailsMember Full registration - $695Non-Member Full registration - $895CA - (conference only) $315Student - (conference only) $315Extra Banquet Tickets Price: $ 150.00 Quantity: Will your partner be attending?YesNoTitleDrMrMrsMsName* First Last Dietary requirementsOther needs/comments: Payment DetailsPayment is via internet transfer, cheque or credit card. For online credit card payments there is a convenience fee.If making payment via Internet transfer please enter your surname and AGM2017 into the references of the bank transaction. The account details are: NZCA Account 02-0506-0145450-00Please make cheques payable to the NZCA and send to:NZCA Seminar 2017PO Box 46127Herne BayAuckland 1011Payment OptionsInternet BankingChequeCredit Card PaymentType of Credit CardVisaMastercardCredit Card Number:Please enter the 16 digit card numberCredit Card Expiry Date:Please enter the 2 digit month and year of the expiry date on the cardTotal $ 0.00 PhoneThis field is for validation purposes and should be left unchanged.