2019 DELEGATE APPLICATION FORM
LDC will take place Sunday 3rd - Friday 8th February, 2019

Please note: The 2019 Chinese New Year (CNY) falls on 5th February which is during LDC 2019. We understand that it is tradition to spend CNY Eve with family and we are open to granting dispensation for those based in Auckland to leave the conference for the evening between the hours of 4pm – 10pm. Please contact nzcaldc@gmail.com if you have further questions.

1. Personal Details
Last Name *
Your answer
First Name(s) *
Your answer
Preferred Name
Your answer
Chinese Name
Your answer
Residential Address *
Your answer
Suburb *
Your answer
City *
Your answer
Country *
Your answer
Postal Address
(if different from above)
Your answer
Contact Numbers
Home e.g. 0XXXXXXXX
Your answer
Work e.g. 0XXXXXXXX
Your answer
*
Mobile e.g. 64XXXXXXXXX or 02XXXXXXXX
Your answer
Email *
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Place of Birth *
(City, Country)
Your answer
Gender *
Languages spoken other than English
Your answer
You finish this application form and walk outside to find a lottery ticket that ends up winning $10 million. What would you do?
Please spend no longer than 3 minutes on this question and write this in 200 characters or less.
Your answer
Are you an NZCA member? *
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