New Zealand Iris Society Inc .....SYMPOSIUM 2000 ......2-6 November 2000

Please complete this form, take a copy for your records and forward it to: Peter Berry, Apt 8D, Tower 1, 1 Marine Parade, Mount Maunganui, New Zealand. Please make cheques payable to Symposium 2000. Bank cheques or drafts only, no personal cheques.

Delegate
Surname: ________________________________________________
Title (Prof/Dr/Mr/Mrs/Ms)
First Name (for name badge): _________________________________
Postal Address: ____________________________________________
________________________________________________________
Telephone: ________________________
Facsimile: _________________________
Email: ____________________________
Special requirements eg: dietary, disabilities, etc.: __________________
_________________________________________________________

The Privacy Act 1993 provides that, before your name and address details can be published in the list of delegates either for distribution to fellow delegates or any other party, you must give your consent. If you DO NOT wish your name and details to be included in the list of delegates please tick: ___

Accompanying Person
Surname: _________________________________________________
Title (Prof/Dr/Mr/Mrs/Ms)
First Name (for name badge): _________________________________

Accommodation
Room type required: Single/Twin/Double
Smoking/Non-smoking
Arrival Date: ________________ Depature Date: _________________
If with a group please state name: ______________________________
If you wish to guarantee your booking by credit card, please tick: _____
otherwise a cheque for NZ$100.00 as a deposit is required.

Payment Summary
Registration Fees (Inclusive of tax): _____________________
Accommodation Deposit: _____________________________
(only required if you are not guaranteeing your booking with a credit card number)

.........................................................................................Total $_______
Please make bank cheque payable to: SYMPOSIUM 2000

Credit Card Authorisation
If paying by credit card please circle the card to be charged:
.............American Express............Mastercard.............Visa
Card Number: ___________________________
Cardholder's Name: _______________________
Expiration Date: __________________________

Card Billing Address: ______________________________________
(if different from address given above)

SIGNED: __________________________________________
Please return by 31st July 2000

Symposium activities will be run in accordance with the events brochure and programme. However, the organising committee will not be held responsible for alterations/cancelations as a result of circumstances beyond its control.