Request Information

To receive further information about the Symposium, please complete this form and submit to the kiwi2006 secretariat electronically, or print and post to:

kiwi2006
PO Box 121 063
Henderson, Auckland 1231
New Zealand
or
Fax to +64 9 812 8503

Title (Dr, Mr, Mrs, Miss, Ms...)

Family name:
First name:

Organisation:

Postal Address:

Phone (Bus.): Fax:

Email:

I would like to: (Please tick appropriate boxes):

	attend the Symposium
	present a paper
	present a poster
	join the pre-Symposium tour
	Number of accompanying persons (0, 1, 2...)

Click the Submit button to send your responses to the kiwi2006 Secretariat. After clicking Submit button, wait until you see the confirmation page. If you have any problems please contact us.

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