REGISTRATION FORM Tax Invoice – GST Registration Number 93 279 352

Please this form electronically please mark the boxes by clicking on the relevant one, it will automatically check. Please email to .

Alternatively complete this form, take a copy for your records and forward it to the address below.

PERSONAL INFORMATION
Organisation
Postal Address
City / Post Code:
Telephone / () / Cellphone / ()
Email
Special Requirements (eg dietary, disabilities)

Please exclude my name from the delegate list.Yes No

NB: Your contact details will be provided to sponsors if you tick the No box.

ATTENDEE NAMES
Name One: / Email:
Name Two: / Email:
Name Three: / Email:
Name Four: / Email:
Name Five: / Email:
Name Six: / Email:
Name Seven: / Email:
Name Eight: / Email:
Name Nine: / Email:
Name Ten: / Email:
REGISTRATION FEES / Early Bird
Prior to 7 February 2015 / Standard
After 7 February 2015
Excl GST / ExclGST
Single Ticket / $ 695.00 / $ 795.00 / $
Multiple Tickets / No of tickets / $ 695.00 / $ 795.00 / $
Table of 10 / $5,950.00 / $6,950.00 / $
Registration Fees Sub-Total (excl. GST) / $
INCLUSIONS
  • Attendance at entire seminar
/
  • Course material

  • Morning and afternoon teas and lunch
/
  • Happy hour post seminar

HAPPY HOUR(takes place immediately following the Seminar)

Iwill attend the happy hour immediately after the seminar I will NOT attend happy hour

ACCOMMODATION(Please note room rates exclude GST of 15%)

Note: To make an accommodation booking, you must either pay a minimum of one night’s deposit either by credit card or invoice. If you wish toarrange a charge back facility this must be arranged between yourself and the hotel. Check in is not available until 2pm.

Rendezvous Hotel

Standard Queen Room - $195.00 per night

/ Standard Twin Room - $195.00 per night
Date of Arrival / Date of departure / Expected Check in Time
If you are sharing the room please give the other person’s name:
If you wish to book multiple rooms click the box and we will contact you

PAYMENT SUMMARY

Method of Payment (please check the appropriate box) Credit Card Invoice me please

  • Registration Fees Sub-Total
/ $
  • Accommodation Payment
/ $
Total / $

PAYMENT OPTIONS

Tax Invoice – GST Registration Number93 279 352. Please make your cheques payable to “The Results Group”

If paying by direct credit, please credit the “The Results Group” bank account no 12-3107- 0044955- 00

Please check card typeMasterCardVisaAmex Diners Club

Card Number: / Expiry Date: / /
Name on Card:
Billing Address:
Signature / Date

CANCELLATION POLICY

Should you be unable to attend once you have registered, you may reassign your registration to another person. Please note you must advise the Secretariat via email . Registration cancellations will not be accepted unless made in writing. Cancellations made on or before Friday 13 March 2015, will be refunded less 30% to cover administration costs. No refunds will be given after this date. If you cancel your accommodation after Friday 20 February 2015, you may be charged a cancellation fee levied by the hotel. If, for reasons beyond the control ofThe RESULTS Group, the seminar is cancelled, the registration fee will be refunded after deduction of expenses already incurred. The RESULTS Groupreserve the right to charge interest on all outstanding debts or for any collection costs relating to outstanding invoices.

Please complete this form, take a copy for your records and email it to .

Alternatively post it C/- Harding Consultants, PO Box 5512, Christchurch.