Scholarship Application is now open

This page will ask you to allow a script on this page to be run to send an email. If this occurs and you then allow it, please be sure to check that the information you entered in the page is still there when you finally press the Submit button to create the email. Please check that the information is all there as you intended before you send the email.

Confidentiality issue: If you are not using your own computer please read this paragraph. This page will send an email to us. If you are not using your own computer then a copy of the sent email will end up on the sent file on the computer you are using. For your own privacy access your own hotmail/gmail/etc account that you normally use when away from your own computer and create a new email on that. Copy and Paste the To field, Subject and Contents of the email displayed into your own email system and send from there. Then just cancel the email that is automatically displayed by this page.

Title (e.g. Mr, Mrs, Dr)
First Name:
Surame:
I confirm I am HIV+
Company / Organisation
Position:
Postal Address:
Street # and Name
Suburb / Town
State
Country
Postcode
Telephone
Fax
email
List any funding assistance that you will receive to attend the conference
If you are attending as an employee - please write your employer's name and contact details here
Check which costs you are applying for.
International Airfare

Hotel Accomodation

Airport transfer and taxes

Conference Registration Fees

Daily Allowance

Opening Ceremony and Receptions

Advertising
How did you hear about the conference? Please select all relevant categories.
Colleague

Your Own Organisation

Through Google Search

Through Body Positive NZ

Through AIDS Foundation/Organisation

News Media

Other:

If you have any special dietary requirements please specify.
If you have any special needs (e.g. wheelchair access) please specify.
Please enter any special accommodation requirements you may have
If you would like to share with someone, please enter their name and advise us whether you require double or twin occupancy:
Have You Submitted an Abstract ?
When you press the Submit button an email form is created which you then need to send to the secretariat. If you do not send the email then the secratariat does not receive your registration.






© 2007 Paul Nash webscool@ihug.co.nz - Last Updated Tue 22 July 2008