Napier Conference: Transfer Payment for registration and conference dinner

 

Personal details
Name
Email address
Payment
Please debit my MasterCard   Visa
Card Number
Card Holder Name Expiry Date
Amount $ (in New Zealand dollars) Date
Signature    

Please complete the form, print the page and return it to Mike Atkinson. You can either mail it to Mike at
Department of Computer Science, University of Otago
PO Box 56, Dunedin 9054
New Zealand
or fax it to: + 64 3 479 8529

If you are paying by cheque please make the cheque payable to: NZ Mathematics Research Institute (Inc.)