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MIFOC07 Auckland, registration Form
Please enter your contact details
First Name
Last Name
Spouse Name
Company
Street
City
State Postcode
Country
Email
Phone Fax
For group booking please provide details of second registrant
First Name
Last Name
Company
Street
City
State Postcode
Country
Email
Phone Fax

For groups of 3 or more please email additional registrant details to autism@xtra.co.nz

Please indicate your area of expertise
All quotes in NZ currency unless specified otherwise
Parent Guardian Osteopath General Practitioner
Paediatrician Chiropractor Health Worker
Nutrition Kinesiology Language/Literacy
Cranial Sacral Neurodevelopment Naturopath
Other (Please specify)
Do you have any key questions?


Where did you hear about the our events?
E-flyer Print flyer Print ad Radio Friend Practitioner
Other (Please specify)

Please indicate what kind of registration you would like
Group discount 20% with 2 or more registering together for any combination of public and/or practitioner events.

Thanks to Vodafone Foundation NZ there are 10 special forum registrations available at half price for parents on limited income.
To apply contact autism@xtra.co.nz 		No. People
2 day pass
May 26-27 $250
  1 Day Pass
26th May, $150
27th May, $150
Practitioners Training
2 day $400
3 day $550
* certified practitioners
 

Mindd Dinner Saturday 26 May
$60 per person No. People
 

Donation
ADD/ADHD/ASD, Dyspraxia and other neurodevelopmental disorders.
$20 Silver $50 Gold $100 Platinum Other Amount
Total Fee: NZD$

Please click here for permission to print your name as a sponsor
Yes No

Payment By online banking:

Name: Mindd
Account:
030351 0112047 00

Please annotate with the name you have registered under. Please send an email with transaction number to confirm payment to admin@mindd.org and cc to autism@xtra.co.nz
By cheque


Mindd Registration
8 Fewtrell Ltd
SOS Inlet Rd.
RD3 Keri Keri
Bay of islands
0293
Please include registration form.
Payment By Credit Card


Click register below for secure online payment with paymate with Master Card or Visa

Refund Policy
For cancellations, please send written notice to info@mindd.org or the above PO Box (no fax). For notices received one week prior to event, your registration fee will be refunded less 25% cancellation charge. No credits will be given for late notice or “no shows”.

I agree with all the terms and conditions outlined above
Yes No

You will be forwarded to the paymate site for online payment.



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