GST: 21 200 239. All Rates Quoted Are GST Inclusive

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

□ 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: