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Registration Form

NZ ASI 2015 Conference, the University of Auckland, 1st - 3rd July 2015

Your email

First Name

Last Name

Preferred name on tag

Affiliation/Institute/Company (to appear on name tag)

Position (please tick box)

If other (please specify)

Best contact phone number

Please check the events you wish to attend

Registration type (please tally your total and enter on PayPal payment page)

I am currently (tick)

If you are interested in joining ASI or need your membership status then please contact Rosyln Kemp roslyn.kemp@otago.ac.nz

Abstracts (tick)

Dietary Requirements

Please tick if you DO NOT wish to have the following included in the delegate list of the conference programme booklet