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Registration Form

NZRDA 25th Anniversary Black Tie Dinner
Registration Form

The Langham Hotel Auckland
4 September 2010
6.30pm onwards

If you would like to help us celebrate 25 years at our black tie dinner at the Langham Hotel Auckland please fill in the registration form below before 20th August.

The cost of the dinner is $150.00 per person and a non-refundable deposit of $50.00 per person is to be paid when submitting your registration and the balance to be paid by Friday 20th August.

We look forward to celebrating this occasion with you

 

First Name: *
Surname: *
Address: *
Email address: *
Contact phone number *
Will you be bringing a partner:
Partners First Name:
Partners Surname:
Special dietary requirements:
Payment - A non-refundable deposit of $50.00 is to be paid when registering and the balance to be paid before 6 August.
Payment Method - You can either pay by direct credit into the bank account number 12-3016-0492242-00 or if you wish to pay by cheque, please make payable to NZ Resident Doctors Associaiton
Do you require infomation on accomodation:
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