Registration form - Stroke Rehab: From No-Tech to Go-Tech, 29th - 31st January 2018, University of Canterbury, Christchurch, New Zealand

Registration form

Date: Monday 29 January – Wednesday 31 January 2018
Venue: Te Puna o Waiwhetu (Christchurch Art Gallery)

There is no refund for registrations after 10th January 2018 or non-attendance

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Attendee details

First name: *

Last name: *

Preferred title:
Miss Ms Mrs Mr Dr Prof

Position:

Organisation / Institution: *

Email address: *

Postal address: *

Phone:

Mobile phone:

Registration options (GST inclusive)

Note: Your registration is complete following payment. When you click the submit button at the bottom of the page you will be taken to the 'Proceed with Payment' page with the conference price option links. Please select your chosen conference price option link and that will take you to the appropriate online credit card payment page. Once your payment is confimed, we will send a confirmation email.

We have three conference options (prices include sessions, lunches, morning / afternoon teas and conference dinner*):

NZ$750 – Professionals **

NZ$520 – Students ***

NZ$1380 – Combined Conference Registration; Dysphagia Intensive Course

* If you have any special dietary requirements (e.g., gluten or lactose intolerance, vegetarian/vegan, etc.), please contact us directly at strokerehabconference@canterbury.ac.nz so we can accomodate your needs.

** If you work as part of a team and wish to have shared attendance (e.g., a single team member attending on different days), please contact us directly at strokerehabconference@canterbury.ac.nz so we can discuss a flexible registration for your group.

*** Must submit verification of student status in writing.  Verification must be received prior to the conference; send letters directly from your Department/Advisor to strokerehabconference@canterbury.ac.nz

Consent for the collection of your data

* I have read the above 'Consent for the collection of your data' and agree to those terms.