REGISTRATION FORM - 18th ANISG/NZNIRSS CONFERENCE & COURSES

ROTORUA, NEW ZEALAND, 9th – 12stAPRIL 2018

*Advise Marlon Reis ( )by2ndFebruary2018ifyou intendtosubmitapaper!

*Return this completed form and payment toSteve Ranford ( ) by2ndMarch 2018 and send your paper to Marlon Reis ( )

1. PERSONAL DETAILS

TitleFirst NameSurname

Organisation

Address

City/TownState PostcodeCountry

TelephoneFaxMobile

E-mail

I have special dietary requirements (give details)

2. SHORT COURSES (9th10thApril)

Half Day Course 1-NIR Basics;Jim De Haseth / Half Day Course 2-Chemometrics;Brad Swarbrick
Full Day Course 1-Hyperspectral Imaging;
Jose Amigo / Full Day Course 2-Sampling for NIR;
Anders Larsen

DAY1 (9th April)

NOTE: ALL PRICES ARE IN NEW ZEALAND DOLLARS (NZD)

xI I will attend Half Day Course 1 NIR Basics(9thApril)($320)

I I will attend Half Day Course 2 –Chemometrics (9thApril)($320)

I I will attend BOTH Half Day Courses 1 & 2(9th April)($495)

I I will attend Full Day Course 1 Hyperspectral Imaging(9th April)($495)

DAY 2 (10th April)

I I will only attend the Full Day Course 2 Sampling for NIR (10th April)($495)

2 DAYS (9th and 10th April)

I I will attend BOTH Half Day Courses 1 & 2 plus Full Day Course 2($850)

I I will attend BOTH Half Day Courses 1 & 2 plus Full Day Course 2 (Student ID)($400)

I I will attend BOTH Full Day Courses 1 & 2 (but no Half Day Courses)($850)

I will attend BOTH Full Courses 1 & 2 (but no Half Day courses) (Student ID)($400)

I will attend the Course Dinner (9th April) (no extra charge)

I require ...... additional Course Dinner tickets @ NZD$70 each for 9th AprilNZD$

Total amount due for Short Courses$

3. CONFERENCE (11th-12thApril)

I will attend the 17th ANISG Conference (11th-12thApril)($595)

I will attend the Conference as an approved Student ($300)

I will attend the Conference Dinner (11thApril) (no extra charge)

I require ...... additional Conference Dinner tickets @NZD$110each for the 11thApril$

Total amount due for ConferenceNZD$

GRAND TOTALNZD$

For tourist activities check

4. ORAL AND POSTER PRESENTATIONS(ADVISE INTENTION BY 2nd FEB 2018)

I wish to present an oral paper

I wish to present a poster

Title of paper

5. PAYMENT OF FEES

NOTE:REFER TO PAYMENT INSTRUCTIONS IN "REGISTRATION" SECTION OF WEBSITE

Option1:Paymentto be made by Direct Credit to New Zealand Westpac Account

03 0255 0216786 00

SWIFT NUMBER WPACNZ2W

ACCOUNT NAME NZ Near Infra-Red Spectroscopy

BRANCH NAME PONSONBY, AUCKLAND, NEW ZEALAND

(Please ensure your surname is included in the ‘particulars’ fields)

  • Please ensure you select the options to addBANK FEES TO THE TOTAL (both sending and receiving banks), or,
  • Inform the bank of the NZD Grand Total in 3 above to be deposited

Check Sending Bank Fees added

Check Receiving Bank Fees added

I have deposited a payment in the NZNIRSS account for a total ofNZD $

(Must match GRAND TOTALabove in 3.)

Option 2: Credit Card



Expiry Date:

Name:Signature:

I require an invoice

I require a receipt