New Zealand Medical Healing Conference 5-8 Sept 2019 Registration Form
Conference Dates: Thurs 5 Sept (6 PM - dinner) – Sun 8 Sept (12 PM - lunch)
Venue: El Rancho Christian Camp, Waikanae - 50 mins drive from Wellington airport
58 Weggery Drive, Waikanae Beach, Waikanae 5036. Ph: 04 902 6287. www.elrancho.co.nz
First Name *
Your answer
Family Name *
Your answer
Title *
Your answer
E-mail address *
Your answer
Your work type *
e.g. nurse, doctor, therapist, student etc.
Your answer
Street Address *
Your answer
Suburb
Your answer
City *
Your answer
Postcode *
Your answer
Country *
Required
Mobile phone number *
No spaces or hyphens please.
Your answer
Registration fee
Your registration fee covers registration and meals. If you are registering and paying for yourself and your spouse, please make sure your spouse registers separately and checks the spouse registration option. If your spouse has registered and paid for both of you, select the "spouse registration" option below. Note: Accommodation is NOT included in the registration fee - see below. Please note: there is NO single session or day registration offered. FULL PAYMENT IS REQUIRED BY 31 AUG 2019.
Accommodation costs
Elm Court. Twin shared bedrooms with single beds. Shared bathroom facilities. Small communal lounge. Bedding and a towel provided. These are NOT serviced units. Cost: $130.00 per person for the three nights. Please pay for this when you register.
Special dietary requirements *
Required
Amount paid
Please enter the amount you will be paying into our account. Please use the format $####.##
Your answer
How to pay
An email confirming your registration will be sent once we receive a completed registration and full payment. Your registration will not be confirmed until your full payment has been received.

Please make your payment to this bank account:

Bank: Westpac
Account Name: PACYFIC Trust
Account number: 03-0578-0130530-00
SWIFT code: (Westpac New Zealand, Wellington): WPACNZ2W (for overseas telegraphic transfers)
Put your "family name" "first name" and "NZMHC19" in the particulars.
Cancellation policy
There will be NO refunds for any cancelled registrations. However, we can transfer your paid registration to another registrant that you nominate before 31 Aug 2019.
Declaration *
I understand that an email confirming my registration will be sent to me once a completed registration and full payment is received. I confirm that I have read, understood and agree to abide by the guidelines contained in the General Information sheet for the conference. Your personal information will be kept safe and not shared with any third party without your permission. If you have any queries, please email nzmedheal@gmail.com. Thank you.
Required
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service