5th International Conference of
Te Ao Māramatanga- New Zealand College of Mental Health Nurses
10 & 11 October 2017
Distinction Hotel and Conference Centre, Hamilton.
Surfing the Waves- Mental Health and Addiction Nurses Responding in New and Innovative Ways.
√ Be in quick as we willbe giving preference to college members to attend the conference and post conference workshops
REGISTRATION FORM(please complete all sections)
Part A:Your details
Surname: / First name:Email address: / Phone contact(s):
Physical address: / Your professional group
Emergency contact person- Name and contact number:
Te Ao Māramatanga NZCMHN membership number:
NB: You must be a financial member of the College to received the reduced registration fee.
Do you have any dietary requirements? If yes please list them below. / Do you have a disability that you require our support with during the conference? Please contact me directly, if you prefer, to discuss your needs.
Name of organisation you work for: / Your position title:
Address and website details of your employer / □DHB □NGO
□Education provider
□Private business
□Government department
□ Other – please specify
Part B: Registration options
There are five options to choose from. Please tick one option and also the relevant registration cost in the following list.
Please take time to view the conference programmeas we are offering a number of post conference workshops. Places in our workshops are limited so we ask that you rank your top four preferences. We will advise you by email which ones you are booked to attend prior to the conference commencing.
Early bird prices end 5pm Friday 15 September 2017
□ Option one-Full conference registration- both days of conference which includes the Fellowship ceremony and dinner on 10 October 2017and the post conference workshop day on 11 October 2017.
NB:Delegates choosing this will be given preference for workshops.
Early bird / NZCMHN member□ $525.00 + GST / Not a NZCMHN member
□ $595.00 + GST / Non-waged, Kuia, Kaumatua, retired nurse, student nurse, service user/tangata whaiora.
□ $200.00
Standard / NZCMHN member
□ $575.00 + GST / Not a NZCMHN member
□ $650.00 + GST / Non-waged, Kuia, Kaumatua, retired nurse, student nurse, service user/tangata whaiora
□ $250.00
My four workshop choices are:
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2.
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4.
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□Option two-One day conference registration with Fellowship ceremony and dinnerfor Tuesday 10 October
Early bird / NZCMHN member□$325.00 + GST / Not a NZCMHN member
□ $395.00 + GST / Non-waged, Kuia, Kaumatua, retired nurse, student nurse, service user/tangata whaiora.
□ $125.00
Standard / NZCMHN member
□ $375.00 + GST / Not a NZCMHN member
□ $450.00 + GST / Non-waged, Kuia, Kaumatua, retired nurse, student nurse, service user/tangata whaiora.
□ $150.00
□Option three- One day conferenceregistration only for Tuesday 10 October 2017
Early bird / NZCMHN member□ $275.00 + GST / Not a NZCMHN member
□ $350.00 + GST / Non-waged, Kuia, Kaumatua, retired nurse, student nurse, service user/tangata whaiora.
□ $90.00
Standard / NZCMHN member
□ $300.00 + GST / Not a NZCMHN member
□ $400.00 + GST / Non-waged, Kuia, Kaumatua, retired nurse, student nurse, service user/tangata whaiora.
□ $100.00
□Option four- Full day post conference workshop registration only
My four workshop preferences are:
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1.
2.
3.
4.
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Early bird / NZCMHN member□ $175.00 + GST / Not a NZCMHN member
□ $250.00 + GST / Non-waged, Kuia, Kaumatua, retired nurse, student nurse, service user/tangata whaiora.
□ $90.00
Standard / NZCMHN member
□ $200.00 + GST / Not a NZCMHN member
□ $275.00 + GST / Non-waged, Kuia, Kaumatua, retired nurse, student nurse, service user/tangata whaiora.
□ $100.00
□Option five–One half day post conference workshop registration only
Myworkshop preferences are:
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1.
2.
3.
4.
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Early bird / NZCMHN member□ $100.00 + GST / Not a NZCMHN member
□ $175.00 + GST / Non-waged, Kuia, Kaumatua, retired nurse, student nurse, service user/tangata whaiora.
□ $75.00
Standard / NZCMHN member
□ $125.00 + GST / Not a NZCMHN member
□ $200.00 + GST / Non-waged, Kuia, Kaumatua, retired nurse, student nurse, service user/tangata whaiora.
□ $70.00
√Here’s a thought you could save around $75.00 if you join the College now as you will recieve the NZCMHN Member price. Go to our website to find out more
Part C: Payment informationMy registration cost is ...... + GST = ......
□ I will pay my own registration.
□ My employer will pay for my registration - details for invoice.
Contact person (invoice will be made attention them): / Contact’s email address:
Website and email details for invoice (if different from contacts email): / Postal address:
Purchase order number:
Payment method
Direct bank payment
□I/wewill deposit the cost of my registration directly into the bank account of Te Ao Māramatanga-NZCMHNurses.
Account name:Te Ao Māramatanga- NZCMNurses
Bank Account No:ASB: 12-3150-0185083-00
Please complete the payee details
- Particulars: First name initial and surname eg: JBloggs
- Code: Register
- Reference: Conference17
Invoice
□Please email me/my organisation an invoice.
Please note: Full amount of invoice to be paid within 14 days of receiving invoice.For your registration to be confirmed all fees must be paid in full before the conference commences on 10 October 2017.
Part D: Terms and conditions
In registering for the 5th International Conference of Te Ao Māramatanga New Zealand College of Mental Health Nurses(NZCMHN) I agree to the following terms and conditions:
Cancellations
All cancellations must be notified to Suzette Poole, Events Director- Te Ao Māramatanga-New Zealand College of Mental Health Nurses in writing by email before the cancellation canbe processed. Cancellations will not be deemed to be received until you have written confirmation from NZCMHN. If the cancellation is not received in writing, the registration will not be cancelled and full registration cost will still be payable.
Cancellations received in writing by NZCMHN on or before 1 September 2017 will be accepted and all fees refunded, less a $100 administration fee. Cancellations received in writing by NZCMHN after 1 September 2017 but on or before 30 September 2017 will be accepted and 50% of delegate fees refunded, which includes a $100 administration fee.Cancellations received after 30 September 2017 are subject to 100% cancellation fee and will not be refunded. Please note non-payment does not constitute as a cancellation. Notentative bookings will be accepted.
Registration fees must be paid
NZCMHN reserves the right to refuse attendance to any delegate/s that have not paid their delegate fees in full.
Emergency contact
NZCMHN has the delegate’s consent to contact their emergency contact if necessary.
Indemnity
Should, for any reason outside the control of NZCMHN, the venue or speakers changeor the event be cancelled, NZCMHN will endeavour to reschedule. In this instance thedelegate will indemnify and hold NZCMHN harmless from and against any and all costs,damages and expenses. NZCMHN does not accept responsibility for, and the delegateindemnities NZCMHN against, any costs, charges or fines incurred by the delegate in theprocess of attending the 5th International Conference of Te Ao Māramatanga New Zealand College of Mental Health Nurses.
□ I accept these terms and conditions
ACCOMMODATION
Please check out our conference webpage for details about accommodation
Be in quick the conference venue has some rooms available at a discounted price
Final steps- Check you have completed all the sections
□Part A:Your details
□Part B: Registration options
□Part C: Payment information
□Part D: Terms and conditions
Submit your registration
Thank you for completing the registration form. The next step is to make sure that this is sent to me. My email address is .
You can send this registration form to me in in one of three ways:
1. Complete this document by typing directly into it and just forward to me via email as an attachment.
2. Print the form out, complete, scan and email it to me.
3. Print the form out, complete and post it to:
Events Director- Te Ao Māramatanga-New Zealand College of Mental Health Nurses
House 1
205 Teasdale Street
Te Awamutu
3800
Confirmation
Please bear in mind that my role as Events Director for the College is voluntary, so I will do my best to ensure we process your registration as soon as possible. However, if you have not received a confirmation email from me within 10 days of sending your registration form please call or text me on 027 510 3995. Thank you.
The Waikato branch of Te Ao Māramatanga New Zealand College of Mental Health Nursesare so looking forward to hosting you in our lovely city of Hamilton, Aotearoa, New Zealand.
Remember the theme is’Surfing the waves’so feel free to dress for the occassion
See you there!
Regards Suzette Poole- Events Director
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