GLAUCOMA NEW ZEALAND SYMPOSIUM 2021

Date:	Sunday 16^th May 2021
Time:	9.00am - 5.00pm
Venue:	Alexandra Park Function Centre, Green Lane West, Epsom, Auckland
Registration:	8.15am – 9.00am
Fee:	$35 Student $115 Livestream rate for Health Professional $155 Health Professional at venue Note: Livestream registrants will be required to complete a questionnaire of 10 questions in the week following the event to achieve accreditation. (6 points)
Professional Education:	6 clinical diagnostic (CD) points or 6 glaucoma education (GE) points

* First Name:

* Last Name:

* Registration type:

Student Professional

* Attendance type:

Livestream In Person

* University year:

* Home Address:

* Student ID:

* Practice Name:

* Practice Address:

* NZAO Number:

Registration Number:

* Email:

Verification Code

Type Verification Code Above

Any special food requirement:

Yes

Yes, I understand that photos will be taken during the event for advertising and marketing purposes.

Yes, I've read and accept the Privacy Policy.*

Privacy Act 1993
The act provides that your name, address and email cannot be published in the list of conference delegates for distribution to fellow delegates or sponsors without your consent. If you DO NOT wish to be included in the delegate list, please tick here

Registration Cancellation Policy:

A refund of registration fees less administration fee of $50 will be made for cancellations received in writing by 3rd March 2021. Please email your cancellation to info@glaucoma.org.nz
The cancellation fee is still payable even if registration fees have not been paid.
Refunds after 3rd March 2021 will be at the discretion of Glaucoma NZ.
If fees have not been paid prior to the conference, and the registrant is unable to attend, the registrant is responsible for and will be invoiced for costs accordingly.
Student refunds will be paid in full.

Registration Fee $ (incl.GST). Receipt will be issued.

Registration Fee:

$ (incl.GST)

Payment options

Direct credit payment to ASB account

GLAUCOMA NEW ZEALAND 123013 0180964 00
Date of direct credit: / /

Ref: Surname
Particulars: Practise name
Credit Card

Payments by cheque: Please print out form, fill in details then send to the address below with your cheque made out to Glaucoma NZ.

Glaucoma NZ
Department of Ophthalmology
The University of Auckland
Private Bag 92019
Auckland 1142

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