AGPS 2018

Delegate Information
Prefix (Mr, Mrs, Dr etc)
First Name*
Last Name*
Institution*
Email Address*
Additional Email Address
Address Line 1
Address Line 2
City*
Postal Code*
Country*
Contact Phone
Mobile Phone*
PO#:
If You Would Like A Purchase Order Number To Appear On Your Invoice, Please Enter It Above.
Dietary Requirements: 
E.g. vegetarian etc.Please leave blank if not applicable.
Special Requirements: 
E.g. wheelchair access etc. Please leave blank if not applicable.
The Privacy Act 1993 requires that, before your name and address details can be published in the list of delegates either for distribution to fellow delegates or any other party, you must give your consent. If you DO NOT wish your name and details to be included in the list of delegates please tick the Privacy Required field above.
Registration
New and return members are welcomed. Please choose AGPS member below. This will automatically register fellows as AGPS member .
Discount Code
(If you have been given a special identifier please enter it here)

Please select from the following options: *


 
* = Required Field

All prices are in New Zealand Dollares (NZD) and include 15% GST
EXCEPT  Membership which is NIL GST

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