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Secure Online Registration and Payment Form

Whether or not you intend to pay online, please be sure to submit this form before you leave this web page.
This will ensure we have your registration information.

If you have a nil balance to pay or require to pay on invoice then please exit the system when it takes you through to the Paypal screen,
after you submit this form.

SP Conference Management will be in touch with payment instructions.

DETAILED CONFERENCE INFORMATION

*Please complete all fields marked with asterisks

DELEGATE DETAILS
REGISTERED DERMATOLOGISTS, TRAINEES & TRADE EXHIBITORS ONLY

Name*

First Name

Last Name

Hospital/Business Name*

Address*

City*

Postcode*

Mobile Telephone*

Email*

Special Requirements - health, diet, mobility, etc.

Delegate List

I do not wish my name and email address to be included in the Delegate List.

Registration*

Registered NZ Dermatologist Registered Australian Dermatologist Registered Visiting Dermatologist NZ Registrar Australian Registrar

Other:

Specify 'Other'

SECTION B - SOCIAL PROGRAMME

Included in Full Registration [Except Conference Dinner for Trade Exhibitors]

Require more information?

Please indicate below if you will attend and the number of extra tickets required.

Welcome Cocktails - Wednesday 2nd August 2023, Millennium Hotel

Yes, I will attend No, I will not attend

(Included in Full Medical/Registrar & Trainee Registration)

Extra Welcome Cocktails tickets required ($50 each)

Numeral

Welcome Cocktails Accompanying Person/s Name

Conference Dinner - Friday 4th August 2023, Winehouse

Yes, I will attend No, I will not attend

(Included in Full Medical Registration/Registrar & Trainee Registration.)

Extra Conference Dinner tickets required ($130 each)

Numeral

Conference Dinner Accompanying Person/s Name

TOTAL TO PAY NOW - REGISTERED DERMATOLOGISTS, TRAINEES & TRADE EXHIBITORS ONLY

GST Number 53-964-354

Payment Summary

A - Total Registration Fees NZ$

B - Social Programme NZ$

C - Accommodation NZ$

Payment online with your credit card will appear on your statement as a transaction with SP Conference Management.

PAYMENT NOW DUE* NZ$

GST Included* NZ$

GST Number 53-964-354

Payment Options*

I will Pay Online after I submit this Form Please Invoice me for Payment Due after I submit this Form No payment due

Donation to NZDRT

Please make a donation to the New Zealand Dermatological Research Trust and pay direct to:

NZDRT 03-0435-0008802-000

Donations are tax deductible.

Message for Conference Manager

Notes:

Confirmation of registration and payment details will be emailed within 5 days.
When you submit this form you will be directed to the SP Conferences Payment Processor.
If you would like to pay on invoice exit at this point. Otherwise proceed to pay.

Thank You for completing and submitting this online registration form.

Sue Peck
Manager

SP Conference Management, PO Box 4400, Palmerston North 4442, New Zealand
Email: sue@spconferences.co.nz Web: www.spconferences.co.nz

Please Note:

Please Check your registration information for accuracy.
We recommend that you Print this Form before you Submit it.
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Whether or not you intend to pay online, please be sure to submit this form before you leave this web page.
This will ensure we have your registration information.
If you are not paying online, please exit after you submit this form.
SP Conference Management will be in touch with payment instructions.