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Health Systems Law Intensive GPCC505

Enrolment Form Title

Mr

Mrs

Miss

Ms

Dr

Prof

First Name Surname Position Company/Organisation Postal Address

City Phone Email Dietary requirements

I wish to confirm my enrolment on the following course. Health Systems Law Intensive Course GPCC505 26 – 30 August 2019 The Wellington Rowing Club Function Room Taranaki Street Wharf, Te Aro, Wellington.

Post with cheque to: Enrolment, Health Systems Law Intensive Faculty of Law University of Otago PO Box 56 Dunedin

Email enrolment form to: law@otago.ac.nz Enrolment, Health Systems Law Intensive Faculty of Law University of Otago Tel 03 479 8857

PAYMENT PREFERENCE Please invoice me Billing Address* * If you ticked “Please invoice me”, enter your personal address and if you ticked “Please invoice my organisation”, enter the organisation address.

Please invoice my organisation

$2,900 + GST

Total $3,335

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Mobile CON DITION S OF E N R OLMENT The University may cancel any course because of insufficient numbers or other unforseen circumstances. The University of Otago is not responsible for any expenses (e.g books/travel/accommodation) that have been incurred.

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