Old Blokes Registration Form

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Old Blokes
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Old Blokes: 15-18 April 2027 - Residential: Karanga Camp, Auckland

Required

Your Information

First Name: *

Last Name: *

Mobile Number:

Daytime Phone Number: *

Email Address: *

Postal Address *

Suburb

Town / City *

Postcode

Which EM Did You Complete (or which year), or what men's work have you done?

Emergency Contact:

For Health & Safety Requirements

Name: *

Phone Number: *

Address: *

Sames address as above

Other:

Required

Relationship to me: *

General Information

Dietary Needs *

Meat is fine

Vegetarian

Dairy Free (DF)

Gluten Free (GF)

Other:

Required

This event is alcohol and drug free and by registering to attend I agree to this *

yes

Required

Car Sharing

I can't offer or do not require car share

I can OFFER car share (enter date and location below)

I REQUIRE car share (enter date and location below)

Car Sharing Comment Box (if applicable)

Are you happy for us to let others in the network know you are attending Old Blokes?

Yes

Required

Preferred Payment Method

Cheque

Internet

Credit Card

Other:

Clear selection

Thank you for registering for the Old Blokes gathering. We will be in touch with you with further details.

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