GLAUCOMA NEW ZEALAND SYMPOSIUM 2020

Date:	Sunday 23^rd August 2020
Time:	9.00am - 5.00pm
Venue:	Alexandra Park Function Centre, Green Lane West, Epsom, Auckland
Registration:	8.15am – 9.00am
Fee:	$135 early bird rate (From 1 March - 31 May 2020) $155 (From 1 June)
Professional Education:	TBC. Up to 5.83 clinical diagnostic (CD) points or 5.83 glaucoma education (GE) points

* First Name:

* Last Name:

* 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 17 August 2020. 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 17 August 2020 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.

Registration Fee $155 (incl.GST). Receipt will be issued.

Registration Fee:

$155 (incl.GST)

Payment options

Direct credit payment to ASB account

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

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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