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Register for the Distinguished Alumni Awards Dinner 2012
Distinguished Alumni Awards Dinner 2012
Please complete this registration form before Wednesday 22 February 2012.
For further enquiries, please telephone Melanie Middleditch 09 373 7599 ext 86409 or email melanie.middleditch@auckland.ac.nz.
Your details
Please enter your name as you would like it to appear on your name tag
First name: *
Family name: *
Date of birth:
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Postal address for tickets: *
Email: *
Contact phone number: *
Society member/staff tickets (110 NZD):
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Standard tickets (120 NZD):
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$
0
NZD
Dietary Requirements:
Please specify if you or your guest have any special dietary requirements.
Do you require mobility parking?
UoA graduate:
Your guests
Full Name:
Email:
UoA graduate:
Full Name:
Email:
UoA graduate:
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