KĀPŌ MĀORI AOTEAROA NEW ZEALAND INC.
BIENNIAL CONFERENCE 2017

EXTERNAL DELEGATE REGISTRATION FORM

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25% of survey complete.

9 - 10 September 2017
Ascott Park Hotel, Invercargill

Please complete a form for each individual attending.

Question Title

* Personal Information

Name

Street Address

Suburb

City

Email

Home Phone

Work Phone

Mobile Phone

Question Title

* Emergency Contact
In the event of an emergency, please provide the name and telephone contact details of the person you would like us to contact:

Name

Relationship to you

Phone

Mobile Phone

Question Title

* Organisation Details
Please provide the details of the Organisation you are representing below.

Name of Organisation

Street Address

Suburb

City

Phone

Email