Ka tū, ka oho – Te matai hinengaro me te ao hou Psychology in a Changing World
New Zealand Psychological Society Annual Conference 2014 29 August - 1 September Rutherford Hotel
NELSON
REGISTRATION FORM Early Bird Registrations close 1 July 2014
Delegate Information Name (for Name badge): ____________________________________________________________________ Workplace (for Name badge): ________________________________________________________________ Address: _________________________________________________________________________________
__________________________________________________________________________________
Phone: _____________________________
Email: __________________________________________
Special requirements e.g. dietary, disabilities etc. _________________________________________________
How to Register Please select the option for your membership/subscriber status at the time of conference. NZPsS members who register for the full conference can select a pre-conference workshop free of charge. Mail this completed form together with your cheque or credit card payment or invoice purchase order to: NZ Psychological Society, PO Box 4092, Wellington 6140 - or fax this to: 04 4734889 - or email: pd@ psychology.org.nz - Online registration and payment is also available on the NZPsS Events page.
Confirmation of Registration Your registration will be confirmed on receipt of your completed form and payment. A confirmation letter/ GST receipt / invoice will be sent to you via email within 7 days. If you have a registration query please contact:
[email protected] or call 04 9141983
Cancellation Policy Cancellations before 1 August 2014, registration refunded less 20% administration fee. After 1 August 2014 no refund but a named substitute can be accepted. I accept the booking conditions and cancellation policy
Privacy The information supplied on this form will be used by the NZ Psychological Society. The Privacy Act requires, that before your name and email address can be published you must give your consent. Unless you advice us below, your name and email address will be included in the list of delegates for distribution to fellow delegates and the exhibitors who are present at the conference. Please indicate if you DO NOT wish your name and details to be included in the list of delegates
1 Conference and full-day workshop package
Please tick your workshop(s) below
Early Bird closes 1 July
Full Members
Early Bird
$ 450.00
Standard
$ 540.00
$ ______________________
Non Members
Early Bird
$ 700.00
Standard
$ 840.00
$ ______________________
NZPsS Student
Early Bird
$ 200.00
Standard
$ 240.00
$ ______________________
Non NZPsS Student*
Early Bird
$ 350.00
Standard
$ 420.00
$ ______________________
2 Conference and half-day workshop package Full Members
Early Bird
$ 450.00
Please tick your workshop below Early Bird closes 1 July Standard $ 540.00 $ ______________________
Non Members
Early Bird
$ 590.00
Standard
$ 708.00
$ ______________________
NZPsS Student
Early Bird
$ 200.00
Standard
$ 240.00
$ ______________________
Non NZPsS Student*
Early Bird
$ 300.00
Standard
$ 360.00
$ ______________________
Full Conference (does not include workshops)
Early Bird closes 1 July
Full Members
Early Bird
$ 450.00
Standard
$ 540.00
$ ______________________
Non Members
Early Bird
$ 500.00
Standard
$ 600.00
$ ______________________
NZPsS Student
Early Bird
$ 200.00
Standard
$ 240.00
$ ______________________
Non NZPsS Student*
Early Bird
$ 250.00
Standard
$ 300.00
$ ______________________
Conference Day Registration (does not include workshops) Saturday
Sunday
Early Bird closes 1 July
Monday PLEASE TICK THE DAY YOU WILL ATTEND
Full Members
Early Bird
$ 170.00
Standard
$ 204.00
$ ______________________
Non Members
Early Bird
$ 250.00
Standard
$ 300.00
$ ______________________
NZPsS Student
Early Bird
$ 80.00
Standard
$ 96.00
$ ______________________
Non NZPsS Student*
Early Bird
$120.00
Standard
$ 144.00
$ ______________________
Workshops on Friday 29 August 2014 You can also choose two half day workshops with Package 1
Member Non-Member NZPsS Student Non NZPsS Student*
Harlene Anderson 9.00am - 5.00pm $200.00
$250.00
$100.00
$150.00
$ ______________________
Michael Daffern
9.00am - 5.00pm $200.00
$250.00
$100.00
$150.00
$ ______________________
Howard/Parkin
9.00am - 5.00pm $200.00
$250.00
$100.00
$150.00
$ ______________________
Joseph Trimble
9.00am - 12.30pm $100.00
$150.00
$50.00
$80.00
$ _______________________
Andrew Munroe
1.30pm - 5.00pm $100.00
$150.00
$50.00
$80.00
$ _______________________
Social Events I will be attending the Welcome Function, Saturday 30th I will be bringing a guest to the Welcome Function
free for conference delegates
$40.00 $ _______________________
I will be attending the Conference Dinner, Sunday 31st
$75.00 $ _______________________
I will be bringing a guest to the Conference Dinner
$75.00 $ _______________________
Payment Details *Non NZPsS Students need to enclose a photocopy of their current student ID to receive a discounted rate PAYMENT - All prices are INCLUSIVE of GST - GST Number 42-486-868 Method of Payment Cheque, payable to New Zealand Psychological Society Inc.
FINAL TOTAL $ ___________________
Direct Credit payment to: Bank of New Zealand, NZPSS Continuing Education, 02-0560-0262471-00 (reference with your surname/
company name)
Date of payment: _____________________ Credit Card payment (MasterCard or Visa only) Cardholder Name: ______________________________________________Expiry Date ____________ Card Number:
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ scan/email/fax/mail this completed form - see details over
