Napier Conference: Transfer Payment for registration and conference dinner


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

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.)