AFFILIATE MEMBERS REGISTRATION FORM - Pacific Power Association

This Registration Form must be completed and submitted online.

REGISTRATION DETAILS

Mr / Mrs / Ms Surname:(required)

Given Name(s):(required)

Position:(required)

Citizenship:(required)

Organization:(required)

Organization Address:(required)

City:(required)

State:(required)

Post Code:(required)

Country:(required)

Business Telephone:(required)

Fax:

Email address(required)

Preferred name for badge:(required)

ACCOMPANYING SPOUSE/PARTNER/CHILD REGISTRATION DETAILS

Surname:(required)

Given Name:(required)

Preferred name for badge:(required)

CONFERENCE SHIRTS

Blouse Size:(required)

Shirt Size:(required)

(please mark shirt/blouse size S, M, L, XL, XXL, XXXL in box provided)

Type the characters(required)

AFFILIATE MEMBER REGISTRATIONS For delegates registering under this category, the registration fee per delegate is US$275.

This field should be left blank

Please wait...