2011 Combined Australian Orthopaedic Association and New Zealand Orthopaedic Association Annual Scientific Meeting (ASM) Delegate Registration Form

Transcription

1 COMBINED ANNUAL SCIENTIFIC MEETING 9 / 14 OCTOBER 2011 ROTORUA / NEW ZEALAND AOA A U S T R A L I A N O R T H O PA E D I C ASSOCIATION 2011 Combined Australian Orthopaedic Association and New Zealand Orthopaedic Association Annual Scientific Meeting (ASM) Delegate Registration Form All fees are in New Zealand Dollars and unless stated otherwise include GST of 15%. GST is payable on all goods and services purchased in New Zealand. Personal Information Please complete the following information. Title First Name* Last Name* Organisation Position Address* (PO Box preferred) Suburb State Work Phone* City/Town* Country* Postcode Fax Mobile Phone Address* (all information will be sent via ) Privacy Required * - required field DELEGATE & PARTNER REGISTRATIONS Early registration applies to all registrations received prior to the 31st July Any registrations recevied, or NOT PAID on or after this date will be charged at the late registration fee. Please note all fees are in NZ$ and include Goods and Services Tax (GST 15%) Delegate registration inclusions are as follows; - Breakfasts as detailed in the conference programme - Morning and Afternoon Teas - Lunches - Welcome Function held in the trade area - Sunday 9th October - Woolshed Function held in the Woolshed - Wednesday 12th October - Black Tie Gala Dinner held in the Sportsdome - Thursday 13th October - Conference Bag Partner Registration inclusions are as follows; - Welcome Function held in the trade area - Sunday 9th October - Woolshed Function held in the Woolshed - Wednesday 12th October - Black Tie Gala Dinner held in the Sportsdome - Thursday 13th October Registration fees DO NOT include the activities for the Annual Sports Afternoon on Tuesday 11th October or the Tourist Activity Afternoon on Friday 14th October.

2 Registration Details $ inc GST New Zealand Registrations NZ Delegate - Early $ GST Affiliated Practitioner (not a Dr, i.e. a Nurse or Student) $ GST Senior (Retired) Member $ GST Australian Registrations Australian Delegate - Early $ GST Affiliated Practitioner (not a Dr, i.e. a Nurse or Student) $ GST Senior (Retired) Member $ GST Rest of the World Registrations Delegate Registration $ GST Affiliated Practitioner (not a Dr, i.e. a Nurse or Student) $ GST Senior (Retired) Member $ GST Accompanying Person From New Zealand $ GST From Australia $ GST From the rest of the World $ GST Namebadge details - Delegate Namebadge details - Partner Delegate and Partner Registration TOTAL $ SOCIAL EVENTS Please indicate which functions you will be attending. Please note that the additional tickets under functions are for additional tickets only, please ensure partners tickets are selected in the applicable box below. Sunday Rugby Welcome Function To be held in the trade area. Viewing of the two quarter finals. Drinks and light snacks will be provided. Sunday Rugby Welcome Function - Attending Oct 9, :30-22:00 Sunday Rugby Welcome Function - Not Attending Welcome Function To be held in the trade area. Drinks and Cocktail food provided. $ Welcome Function - Attending Oct 10, :00-19:30 Welcome Function - Additional Ticket Oct 10, :00-19: Welcome Function - Not Attending

3 Wednesday Woolshed Function To be held in The Woolshed which is adjacent to the meeting venue. $ Drinks and substantial cocktail style food provided. Wednesday Woolshed Function - Attending Oct 12, :00-20:30 Wednesday Woolshed Function - Additional Ticket Oct 12, :00-20: Wednesday Woolshed Function - Not Attending Gala Dinner To be held at the conference venue. $ Delegate Attending Oct 13, :00-23:45 Additional Ticket Oct 13, :00-23: Delegate Not Attending Accompanying Partners Programme The below options are included in the partners registration fee. Please tick the relevant boxes to indicate your attendance. If you do not tick the boxes it will be assumed you are not attending. Sunday Rugby Welcome Function To be held in the trade area. Viewing of the two quarter finals. Drinks and light snacks will be provided. Oct 9, :30-22:00 Welcome Function To be held in the trade area. Drinks and Cocktail food provided. Oct 10, :00-19:30 Nigel Latta Session Venue to be advised, morning tea will be provided Oct 11, :00-11:00 Wednesday Woolshed Function To be held in The Woolshed which is adjacent to the meeting venue. Drinks and substantial cocktail style food provided. Oct 12, :00-20:30 Gala Dinner To be held at the conference venue. Oct 13, :00-23:45 Sports Day Partners are welcome to join in these activities also. GOLF The Golf Tournament will be held at the Wairakei International Golf Course. Designed by Commander John Harris, Michael Wolveridge and Peter Thomson with the aim of producing New Zealand s first internationally recognised golf course, there is little doubt in any New Zealanders mind that this trio exceeded all expectations. The end result is a course that sprawls over 450 acres of natural countryside. This coupled with the 6444 metres from the championship tees and 108 large well placed bunkers has led to worldwide acclaim. Golf Tickets Include; Return transport from Rotorua, Lunch, Carts, Green Fees, Prizegiving and clubhouse drinks post game. $ Participants are limited to 120 Oct 11, :00-19:

4 MOUNTAIN BIKING The Mountain biking event will be held in the Whakarewarewa Forest and hosted by Planet Bike. Beginners, Intermediate and Advanced courses will be offered. Biking Tickets Include; Return transport, lunch, drinks, all cycling and safety equipment, course marshalls and first aid. $ Participants are limited to 120 Oct 11, :00-17: TENNIS $ FISHING Oct 11, :00-17: The Fishing will be held on Lake Okataina and be based at the Okataina Lodge. 5 Fishing boats will be used during the afternoon (1 large and 4 smaller boats). Jigging will be the fishing method used and participants will be rotated between the smaller and larger vessels. After fishing drinks and a light meal will be provided, whilst the fish caught will be smoked. Fishing Tickets Include: Return transport, lunch, fishing gear and licenses, Prizegiving and drinks at Okataina Lodge. $ A maximum number of 50 participants applies to this activity. Oct 11, :00-19: Social Events TOTAL $ PARTNERS PROGRAMME Below is the partners programme that will take place on each of the days. Please note that numbers for some tours have both minimums and maximums, if the tours do not reach the numbers, they will not go ahead and monies will be refunded or put towards another tour option. Please note that some tours are not suitable for children - please refer to the partners programme page on the website for more information. All tours will drop off and pick up outside the Rotorua Energy Events Centre. Costs for these tours are additional to the registration for partners. Please enter the number of tickets you would like for each tour however please check timings for the tours to ensure you will be able to do more than one on each day if that is what you wish to do. To ensure people do not miss out, some of the options are repeated on several days. Monday Partners Programme Activity Date Depart/Return $ Wai O Tapu Adult Oct 10, :00-14: Wai O Tapu Child Oct 10, :00-14: Pinnies and Parties Cooking Demonstration Oct 10, :00-14: Tarawera Fall Guided Hike Adult Oct 10, :00-16: Tarawera Falls Guided Hike Child Oct 10, :00-16: Te Puia Adult Oct 10, :30-12: Te Puia Child Oct 10, :30-12: Agrodome Sheep Show Adult Oct 10, :30-17: Agrodome Sheep Show Child Oct 10, :30-17: Kaituna River Rafting Oct 10, :00-17:

5 Rainbow Springs Kiwi Encounter Adult Oct 10, :30-17: Rainbow Springs Kiwi Encounter Child Oct 10, :30-17: Tuesday Partners Programme Tickets to Tuesdays sport afternoon activities with the delegates can be purchased. Activity Date Depart/Return $ Rainbow Springs Kiwi Encounter Adult Oct 11, :00-11: Rainbow Springs Kiwi Encounter Child Oct 11, :00-11: Te Puia Adult Oct 11, :00-11: Te Puia Child Oct 11, :00-11: Wednesday Partners Programme Activity Date Depart/Return $ Rainbow Springs Kiwi Encounter Adult Oct 12, :30-17: Rainbow Springs Kiwi Encounter Child Oct 12, :30-17: Te Puia Adult Oct 12, :30-12: Te Puia Child Oct 12, :30-12: Agrodome Sheep Show Adult Oct 12, :30-17: Agrodome Sheep Show Child Oct 12, :30-17: Kaituna River Rafting Oct 12, :00-17: Thursday Partners Programme Activity Date Depart/Return $ Off Road NZ - Adrenalin Overdose Adult KartSport circuit and Monster 4 x 4 Oct 13, :00-12: Off Road NZ - Adrenalin Overdose Child KartSport circuit and Monster 4 x 4 Oct 13, :30-16: Off Road NZ - Adrenalin Overdose Adult KartSport circuit and Monster 4 x 4 Oct 13, :30-16: Off Road NZ - Adrenalin Overdose Child KartSport circuit and Monster 4 x 4 Oct 13, :00-12: Off Road NZ - Monster 4 x 4 Adult Oct 13, :00-12: Off Road NZ - Monster 4 x 4 Child Oct 13, :00-12: Off Road NZ - Monster 4 x 4 Adult Oct 13, :30-16: Off Road NZ - Monster 4 x 4 Child Oct 13, :30-16: Kaituna River Rafting Oct 13, :00-17: Partners Programme Total $

6 ACCOMMODATION These accommodation terms, conditions and booking processes have been imposed by the hotels due to the 2011 Rugby World Cup To book accommodation please do so below. Full pre-payment via bank transfer or credit card will be required. All reservations must be fully paid for at the time of booking. 100% Cancellation charges apply from 31 July night stays (in 09/10/11 and out 14/10/11) can only be reserved. If you require nights outside of this, please enter the information in the Special Hotel Requirements space in the next section of the registration process. Please select Cost per room per night in NZD $ No Accommodation Booking Required Ibis Rotorua Ibis Guest Room Millennium Hotel Rotorua Superior Twin Room Superior King Room Superior Plus Twin Room Club Room One Bedroom Suite Superior Plus King Room Novotel Rotorua Junior Suite Executive Suite Novotel Guest Room Rydges Rotorua Deluxe King Room Deluxe Twin Room King Spa Suite Holiday Inn Standard Room Accomodation Total $ Booking Details Check-In Date: Check-Out Date: Special Requirements Please enter any special requirements you may have below:

7 FURTHER INFORMATION Please enter in the space below any information that we may need to know about your registration. Special Dietary Requirements Sports Day Information Please enter any relevant information in relation to your attendance at the Sports Day afternoon on Tuesday the 11th. For example your current Golf handicap and NZGA membership number. Special Requirements Special Hotel Requirements If you require accommodation for dates other than those offered please enter them here.

8 PAYMENT DETAILS Please select one of the following payment options below. All transactions by credit card will appear on your statement as a payment to Convention Management New Zealand Limited. If you wish to pay by cheque, please forward your cheque to: AOA NZOA 2011 c/o Convention Management New Zealand Limited PO Box Henderson Auckland 0650 All prices are in NZ$ and include GST (Goods and Service Tax) of 15% PAYMENT Please enter your calculated totals for each section: Delegate and Partner Registration TOTAL $ Social Events TOTAL $ Partners Programme TOTAL $ Accomodation TOTAL $ TOTAL AMOUNT DUE $ Option 1 - Please send me an Invoice Option 2 - Please provide your credit card details: American Express Mastercard Visa Card Number: Name on Card: Amount: $ Signature: Expiry: / Security code: Send completed form back to: AOA NZOA 2011 c/o Convention Management New Zealand Limited PO Box Henderson Auckland 0650 Fax: aoanzoa@cmnzl.co.nz

9 CANCELLATION POLICY/TERMS AND CONDITIONS Any registration amendments and/or cancellations must be notified in writing to the Meeting Managers, Convention Management (CM). Conference registration cancellations received in writing before 31 July, 2011 will be refunded in full less an administrative fee of $ Cancellations received after that date will not receive refunds unless exceptional circumstances prevail. Substitute delegates are welcome without penalty, but please advise the Meeting Managers of any name changes. In the event that the meeting is cancelled by the organisers or CM, or by any reason of any factor outside the control of the Organisers or CM, the conference cannot take place; the amount of the Registration Fee shall be refunded, less an administrative fee of $ The liability of the Organisers and CM shall be limited to that refund and neither shall be liable for any other loss, cost or expense, however caused, incurred or arising. In particular, neither the Organisers nor CM shall be liable to refund any travel or hotel costs incurred by delegates or their organisations. It follows that delegates and accompanying partners are advised to take out comprehensive insurance, including travel insurance. Accommodation Cancellations after July the 31st, 2011 or no shows at the hotel will not be refunded. Accommodation cancellations before July the 31st, 2011 will incur a one nights cancellation fee. Non payment of any invoice issued will be passed onto a collection agency. Collection costs will be the responsibility of the debtor. DISCLAIMER Neither the Organising Committee of the Combined AOA and NZOA Meeting, 2011 and its constituent members acting as organisers (known collectively as the Organisers ), nor Convention Management (CM), can accept any liability for death, injury, any loss, cost or expense suffered by any person (including accompanying persons or partners or attendant caregivers), if such loss is caused or results from the act, default or omission of any person other than an employee or agent of the organisers or CM. In particular, neither the Organisers nor CM can accept any liability for losses arising from the provision or non-provision of services provided by hotel companies or transport operators. Nor can the Organisers or CM accept liability for losses suffered by reason of war including threat of war, riots and civil strife, terrorist activity, natural disasters, weather, fire, flood, drought, technical, mechanical or electrical breakdown within any premises visited by delegates and/or partners in connection with the meeting, nor losses suffered by reason of industrial disputes, governmental action, registrations or technical problems which may affect the services provided in connection with the meeting. Neither the Organisers nor CM is able to give any warranty that any particular will appear as a speaker or panelist. Please tick to complete registration: I accept the above terms and conditions Enquiries or further information please contact: Convention Management New Zealand Ltd PO Box , Henderson, Auckland 0650, New Zealand Ph (during NZ office hours) paul@cmnzl.co.nz