| PRIMARY REGISTRANT
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| Title: |
Ms
Mr
Mrs
Miss
Dr |
| Surname: |
* |
| Given Name: |
* |
| Name Badge to Read: |
*
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| Organisation (If Applicable): |
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| Postal Address: |
* |
| Town/City: |
* |
| State/Province: |
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| Zip/Post code: |
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| Country: |
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| Your Email: |
* |
| Fax: | |
| Phone: |
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| Mobile: |
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| OTHER REGISTRANT'S BADGE NAMES |
| Other Name (2): |
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| Other Name (3): |
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| Other Name (4): |
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I confirm that I am over the age of 18 and that I am not registering any persons that are under the age of 18.
*
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| ANY SPECIAL DIETARY REQUIREMENTS? |
| Dietary Requirements: | |
| ACCOMMODATION REQUEST |
|
Millennium Hotel: Superior Room Double
NZ $225 GST inclusive and for room only (breakfast extra) |
Please reserve me
room/s |
|
Millennium Hotel: Superior Room Single
NZ $205 GST inclusive and for room only (breakfast extra) |
Please reserve me
room/s |
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Note that Queenstown accommodation is filling up fast over the Celebration period. Please make sure that you secure your accommodation as soon as possible. There are rooms held for Celebration Delegates at several conveniently located establishments (some at special rates) - please check this box if you would like to be sent information on accommodation options. Note that the Millennium is already fully booked.
Please send information on accommodation options:
Please enter any additional information here:
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| PAYMENT CALCULATION |
REGISTRATION FEE PER PERSON
Fee covers full attendance from 6.30pm Thursday, 26th January
concluding with The Grand Dinner on Saturday, 28th January 2012 (incl GST)
|
|
BEFORE 17th JANUARY 2012 - Full Programme |
NZ$1196 ×
$
|
CENTRAL OTAGO MASTERCLASS -
Thursday 26th January |
NZ$90
- Sorry, Sold Out
×
$
|
ACCOMMODATION DEPOSIT:
(equivalent to one night's tariff) |
($225 for each double room reserved as above. $205 for single room) NZ$
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TOTAL TO CHARGE
(please note charges are made in NZ dollars) |
Grand Total: NZ$
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| Privacy |
I DO NOT wish my name, address, and other details to be included in any list of attendees. |
| I will be attending the Central Otago Welcome Aperitif on Thursday evening 26th Jan |
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| Terms and Conditions |
*
I acknowledge that I have read and understood the terms and conditions, including the refund policy, of the Celebration listed at: www.pinotcelebration.co.nz
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METHOD OF PAYMENT - we will contact you with details for payment via credit card or PayPal.
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| The terms and conditions of registration for the Celebration including the refund policy can be viewed here [terms and conditions]
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| All communications to: Richard Broadhead, PO Box 245, Cromwell 9342, New Zealand; Telephone: +64 3 445 4650
Fax: +64 3 445 4620, Mobile: +64 21 340 994, E-mail: pinot.noir@paradise.net.nz
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