Police or Medical Officer of Health IPD registration

Police or Medical Officer of Health IPD

REGISTRATIONS ARE NOW CLOSED

Please use this form to register up to 10 officers. If you are registering more than 10, then you will need to submit multiple forms.

DATE : 5 - 7 September 2023

Please fill in one form per Police District / District Health Board
Payment is by direct credit only.
The registration fee is $290 per officer. Details will be provided once you have submitted this form.
NZILLI is not GST Registered. NO INVOICES WILL BE GENERATED.

Registrations close at 5pm on Friday 18 August 2023.

Purchase order number (optional)

Number of officers you are registering *

Total fee payable *

Please fill in the total as indicated in red.

1 officer

Total registration fee :$290.00

2 Officers

Total registration fee : $580.00

3 Officers

Total registration fee : $870.00

4 Officers

Total registration fee : $1,160.00

5 Officers

Total registration fee : $1,450.00

6 Officers

Total registration fee : $1,740.00

7 Officers

Total registration fee : $2,030.00

8 Officers

Total registration fee : $2,320.00

9 Officers

Total registration fee : $2,610.00

10 Officers

Total registration fee : $2,900.00

Police or Medical Officer of Health? (tick one) *

Police

Medical Officer of Health

District *

Postal Address *

Email address to receive a copy of this registration *

REGISTRATION FOR IPD

Name of officer 1 *

Job title *

Phone number *

Email *

How many years have you been involved in alcohol licensing at your current position? *

How many years have you been involved in alcohol licensing over all your career? *

Do you have any special dietary requirements? *

YES

If YES > Please state dietary requirements

Name of officer 2

Job title

Phone number

How many years have you been involved in alcohol licensing at your current position?

How many years have you been involved in alcohol licensing over all your career?

Do you have any special dietary requirements?

YES

If YES > Please state dietary requirements

Name of officer 3

Job title

Phone number

How many years have you been involved in alcohol licensing at your current position?

How many years have you been involved in alcohol licensing over all your career?

Do you have any special dietary requirements?

YES

If YES > Please state dietary requirements

Name of officer 4

Job title

Phone number

How many years have you been involved in alcohol licensing at your current position?

How many years have you been involved in alcohol licensing over all your career?

Do you have any special dietary requirements?

YES

If YES > Please state dietary requirements

Name of officer 5

Job title

Phone number

How many years have you been involved in alcohol licensing at your current position?

How many years have you been involved in alcohol licensing over all your career?

Do you have any special dietary requirements?

YES

If YES > Please state dietary requirements

Name of officer 6

Job title

Phone number

How many years have you been involved in alcohol licensing at your current position?

How many years have you been involved in alcohol licensing over all your career?

Do you have any special dietary requirements?

YES

If YES > Please state dietary requirements

Name of officer 7

Job title

Phone number

How many years have you been involved in alcohol licensing at your current position?

How many years have you been involved in alcohol licensing over all your career?

Do you have any special dietary requirements?

YES

If YES > Please state dietary requirements

Name of officer 8

Job title

Phone number

How many years have you been involved in alcohol licensing at your current position?

How many years have you been involved in alcohol licensing over all your career?

Do you have any special dietary requirements?

YES

If YES > Please state dietary requirements

Name of officer 9

Job title

Phone number

How many years have you been involved in alcohol licensing at your current position?

How many years have you been involved in alcohol licensing over all your career?

Do you have any special dietary requirements?

YES

If YES > Please state dietary requirements

Name of officer 10

Job title

Phone number

How many years have you been involved in alcohol licensing at your current position?

How many years have you been involved in alcohol licensing over all your career?

Do you have any special dietary requirements?

YES

If YES > Please state dietary requirements

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