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Name
*
First
Last
Business Street Address
*
Suburb
*
State
*
New Zealand
Australian Capital Territory
New South Wales
Northern Territory
Queensland
South Australia
Tasmania
Victoria
Western Australia
Mobile Phone Number
*
Email
*
Your Business Brand
*
LASER
O'BRIEN
NETWORK MEMBER
SUPPLIER
Trade:
*
Please Select
ELECTRICAL
PLUMBING
ELECTRICAL & PLUMBING
SUPPLIER/SPONSOR
STAFF O'BRIEN/LASER GROUP
ENTER YOUR TRADE HERE
YOUR BUSINES TRADING NAME, FOR MEMBERS WITH MULTIPLE TRADES
Please only use this field if you have additional trades in your Member Business IBL as part of your Business Name - (if not shown in the above check box)
Your Business Name Location / (Suppliers - please input Company Name)
*
ie; if your business name or business location is Laser Electrical Rosebank - only type 'ROSEBANK' here
Would you like to add any people as full delegates?
*
No
Yes
Additional Delegate #1
First
Last
Additional Delegate #2
First
Last
Additional Delegate #3
First
Last
Additional Delegate #4
First
Last
Additional Delegate #5
First
Last
Would you like to add any people for the Social events only?
NO
YES
Additional Social Person #1
First
Last
Additional Social Person #2
First
Last
Additional Social Person #3
First
Last
Additional Social Person #4
First
Last
Would you like to add any people for the Gala event only?
NO
YES
Additional Gala Person #1
First
Last
Additional Gala Person #2
First
Last
Additional Gala Person #3
First
Last
Additional Gala Person #4
First
Last
Itinerary Support (optional)
Do you require support with itinerary, International or domestic flights to Wellington, ground transfers from Wellington airport, accommodation bookings for groups etc? Let us know how we can help
Is there any additional information or request you would like to add to your registration? Please do indicate any specific dietary requests here.
add Dietary needs here.
Video & Photography consent
*
Yes I/We consent to Video and Photography during the conference event
You and your delegates consent to: Us (O’Brien Glass Industries Limited) or our partners taking photographs, and making audio and video recordings of you at the Conference (Recordings); and Us sharing the Recordings to promote the Conference in any manner we see fit. You and your delegates understand and agree that we own all rights (including copyright and other intellectual property rights) to the Recordings. You and your delegates agree and understand that: We are under no obligation to use, or pay you for, our use of the Recordings; and You will have no right of approval, no claim for compensation, and no claim (including claims based on the invasion of privacy, moral rights, defamation or right of publicity) arising out of or directly or indirectly from the use and publication of the Recordings.
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