National Conference on Risk Management

6th National Conference on Risk Management
6 & 7 September 2012
Te Papa, Wellington

5 September 2012 – Pre Conference Workshop

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All information should be typed in upper and lower case (eg: Mary Smith). On completion of the form, click on the "Submit Registration" button at the end of this form. You have the option of paying either by cheque or credit card (using a secure site) A Tax Invoice will be sent to the email address you provide, which may be printed.
Personal Information
Surname
First Name
Title (Mr/Mrs/Ms/Dr/Prof)
Organisation
Position
Postal Address
Locality	Town/City (or Country if living outside of New Zealand)
Daytime Telephone	Format: NZ = 01 234 5678, International = +_ _ 1 234 5678
Home Telephone	as above
Mobile Phone	as above
Email	Please ensure that your email address is correct as your invoice and all correspondence will be sent to this address.
Special Requirements	Dietary: please describe
	Mobility: please describe
	Other: please describe
Preferred Name Badge	First Name: Last Name:
Privacy Act The Privacy Act (NZ) 1993 states 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 your consent. If you do not wish your name, address and details to be included in the list of delegates or provided for use by the forum major sponsors, please tick this box.

Conference Fees (GST Exclusive)

Discount
A discount of $50.00 applies if attending the full conference AND the half-day workshop.

Group Bookings
A special discounted booking rate of $635.00 is available to individuals and corporate members in groups of 4 or more.

To begin your registration, are you booking as an

individual
a member of a group attending the full conference

For all enquiries please contact the conference organiser:

Dave Treeby
Director
Phone: [+64] 4 232 4350
Mobile: [+64] 27 242 1019
Email: dave@eventuate.co.nz

Eventuate (Wgtn) Ltd
P O Box 51-185
Tawa
Wellington 5249
NEW ZEALAND

Ph/Fax: [+64] 4 232 4350

Lisa Treeby
Project Coordinator
Phone: [+64] 4 232 4350
Mobile: [+64] 27 439 9968
Email: lisa@eventuate.co.nz