DCMI NZ 2021 Registration form

IMPORTANT! Before completing this registration form, please read the Terms & Conditions of Travel and the General Terms & Conditions of Travel.
Please note: This form will save automatically upon pressing "Next", however, you may also want to Save Draft if you'd like to return to the registration form at a later point.

Traveller Type

(note: each traveller must complete this form separately)

Full Delegate

Twin share delegate (2 delegates sharing)

Delegate partner (accompanying family or friend of full paying delegate)

Travel Partner

(if travelling as a twin share or delegate partner, put partners name here)

Your Personal Details
(Please ensure you provide complete, correct information)

Title

Mr.

Mrs.

Miss

Dr.

Last Name

(as it appears on your passport)

First Name

(as it appears on your passport)

Middle Name

(as it appears on your passport)

Name confirmation

Yes, the name above is an exact match for the name on my passport.

Preferred name for name badge

Organisation

Role in organisation

Email Address

Mobile Phone Number

Postal Address

(we will use this address to post your pre-tour information packs)

Your Passport
(It is your responsibility to have a valid passport. If you do not currently hold a valid passport, please indicate this by writing NO PASSPORT in the boxes below. You may also provide the details to us later, in which case write LATER in the boxes below.)

Passport Nationality

Passport Number

Passport Expiry Date

Date of Birth

Emergency Contact Details
(Please nominate a contact person in case of emergency while travelling.)

Emergency contact name

Emergency contact phone

Additional details

Would you like Flight Centre to help arrange your international flights?

Flight Centre is tours dedicated travel agent.

Yes, please have Flight Centre contact me

No, I will arrange my own international flights

Do you have any special dietary requirements?

Yes

No

Please identify any special travel requirements you may have, such as dietary requirements:

Deposit Payment

In our attempt to secure this trip at a good exchange rate and in an endeavour to avoid, where possible, increased tariffs due to rate rises the trip cancellation / payment fees are stringent and are as follows:

Deposit $1,500 per person on booking
Payment 2 $3,000
Final payment Balance
Each payment is non-refundable / cancellation fees match payments

Deposit Payment Type

How would you like to pay the deposit amount of 20%?

Credit Card (surcharge applies)

Direct Deposit / BPay

Credit Card Payment
(note: surcharge applies as per the DCMI Terms & Conditions of Travel document)

Card type

Visa

Mastercard

American Express

Diners Club

Name on Credit Card

Credit Card Number

Credit Card Expiry

Airline Loyalty Programs

Are you a member of an Airline Loyalty Program?

Yes

No

What is your Loyalty Program membership number?

Level of Membership

Travel Insurance
Please note, it is a requirement that every delegate have travel insurance. If you do not have the insurance now you can leave this blank, however you will need to arrange your insurance well before you travel.

Travel Insurance company

(If I know)

Travel Insurance number

(If I know)

Travel Insurance overseas emergency contact number

Confirmation and Acceptance

Terms & Conditions Agreement

I acknowledge that I have read and understood the DCMI terms and conditions of travel and the DCMI General Terms and Conditions of Travel

Indemnity details

I affirm that I am participating in DCMI tour, organised by DCMI of my own free will and I am fully aware of the possible risk involved and accept the same, notwithstanding the fact that this trip is intended only for those without serious medical problems and who are fit enough to attend this Industry Tour.

I confirm that I am participating on my own volition and I shall not hold DCMI, its employees, volunteers and organisers responsible or in any way liable for my death, injury, disability or an loss or damages (including, without limitation and to the extent permissible by law, personal injury, loss of life or property damage) whatsoever arising from any cause in connection with my participation in the Tour therein.

I (including my heirs, successors and assigns) will indemnify and indemnified, save and hold harmless DCMI, its employees, organisers, volunteers against all losses, claims, demands, actions, proceedings, damages, costs or expenses, including legal fees, and any other liability arising in any way from or in connection with my participation the Tour therein.

Are you or your organisation a member of?

(tick all relevant)

ACSA
LASA
GAN (Global Ageing Network)
CommonAge

How did you hear about this tour?

Acknowledgement

(Please Check to acknowledge our Terms and Conditions of Travel)

By submitting this registration form you are agreeing to the DCMI terms and conditions of travel and the DCMI General Terms and Conditions of Travel