Health Systems Law Intensive GPCC505
Enrolment Form Title
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: firstname.lastname@example.org 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
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.