Name *

First Name

Last Name

Postal Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Please tick if you are not a chaplain but interested in chaplaincy

Please indicate your payment preference *

The Conference fee is $90 for Chaplaincy NZ members or $120 for non members.

Cash / Cheque - on the day only please. Please make any cheques payable to Chaplaincy New Zealand Trust.

Westpac Deposit - prior to the conference. Please use your name as the reference. Chaplaincy New Zealand Account for payment is: 031562 0070355 00.

Receipts will be available at the Registration Desk if required.

Please indicate if you need a receipt prior to the Conference Date

Yes

No

Cost inclusive of all meals (including dinner on the Friday night) except for breakfast.

Dietary Requirements (if any)

Vegetarian

Gluten Free

Other (please state)

Have you attended a previous Chaplaincy NZ conference?

Yes

No