GST: 21 200 239. All rates quoted are GST inclusive
First Name (for Badge) ..................................................... Family Name ...........................................................................................
Company Name .....................................................................................................................................................................................
Postal Address ........................................................................................................................................................................................
Suburb/City ........................................................................ .Area code ............................................................................................... .
Phone ................................................................................... Mobile.......................................................................................................
IPWEA NZ Member Yes/No? ......................................... .Email .......................................................................................................
Special dietary requirements ..............................................................................................................................................................
Forum Two Day registration fee - Includes all components as detailed including morning and afternoon teas, lunches,
happy hour and forum pack. Dinner is optional / extra
If attending Thursday, please tick what stream you will be attending
□ Optomised Decision Making or □ Corridor Management
Register Early – register prior to 25 Dec and be in the draw to win one dozen bottles of Canterbury wine
Up to 1 Feb
After 2 Feb
Two day Forum
□ Member - Full Registration
$626
$726
$ .............................
□ Non-Member - Full Registration
$681
$781
$ .............................
One Day
□ Member – One day
$339
$389
$ .............................
□ Non-Member – One day
$369
$419
$ .............................
If attending One day only, please state if Wednesday or Thursday ………………..
Forum Dinner, Wednesday evening at Rendezvous Grand Hotel, Auckland
Number of tickets …..@ $95 per person
$ .............................
Accommodation – Rendezvous Grand Auckland (forum venue)
It is necessary to prepay one night to guarantee your booking
Room rate per night - $205 – Superior room
Breakfast @ $22 per person. Include Breakfast? Yes/No
$ .............................
$ .............................
Arrival Date............................................................ Departure Date .............................................
TOTAL DUE $
Payment Details
□ Invoice Required
□ Mastercard/Visa Please note: 3% surcharge will apply to all Mastercard / Visa transactions
□ Direct Credit
Bank Account: Institute of Public Works Engineering Australasia New Zealand Division Inc
Westpac, Thames Branch
Account 030 458 0264788 27
Please send email acknowledgement to [email protected]
□ Cheque enclosed (please make payable to IPWEA – RIMS/IDS Forum)
Cardholders Name .......................................................................................................................................................
Card Number .................................................................................................................................................................
Expiry Date ........................... Cardholders Signature...................................................... CVN No …………….
Please complete and return to: Road Infrastructure Management Forum 2015
C/O The Conference Team
PO Box 20-051, Christchurch, 8543
Phone: 03 359 2600 Fax: 03 359 2602 Email: [email protected]
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 consent. If you DO NOT wish your name and details to be
included in the list of Forum attendees/sponsors, please tick □