LDI Registration Form

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In order to process your registration, we ask you to provide the following information. Please note that all fields marked with an asterisk (*) are required. Make sure to hit the submit button in order for your registration to be processed.

The form will be automatically sent to us upon completion and we will get back to you within the following 48 hours to confirm that it has been received.

Any special deals applying to your registration but not reflected on this form will be reflected on your invoice.

Which LDI? *

October 4-8, 2021

November 8-12, 2021

Which Package? (all prices exclude GST) *

Silver Package : Early Bird $6,165 (payment due sixty days before course start date)

Silver Package : Standard $6,415

Gold Package : Early Bird $6,915 (payment due sixty days before course start date)

Gold Package : Standard $7,165

Platinum Package : Early Bird $8,415 (payment due sixty days before course start date)

Platinum Package : Standard $8,665

Other - by prior arrangement with LDINZ only

PERSONAL INFORMATION

Full name: *

Title / position:

Phone numbers: *

Preferred email address: *

Company name: *

Physical address of company (including post-code): *

Special food requirements (eg. vegetarian, gluten free, any food allergies) *

Do you have any medical conditions we should know about? *

Room preference *

Room to myself

Room shared with spouse or partner

Room shared with another participant

Other:

Roommate's name if sharing: *

EMERGENCY CONTACT whilst on LDI

Name: *

Relationship to you: *

Home phone:

Work phone:

Mobile: *

TERMS AND CONDITIONS

By ticking the box you agree that you have read and accept the LDI terms and conditions. *

LDI Terms and Conditions (https://www.ldinz.co.nz/terms-and-conditions)

Required

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