Convergence (Dec 28th 2011 – Jan 3rd 2012)
REGISTRATION FORM:
Please complete and post with your cheque made payable to “CONVERGENCE”
(To bank directly please check instructions on website www.convergence.net.nz “Event Details / Payment Details” page)
Post to: CONVERGENCE
P.O. BOX 13 329
CHRISTCHURCH 8141
First Name Family Name Age 0 -18 or Adult $
_____________ ________________________ _____________ $________
_____________ ________________________ _____________ $________
_____________ ________________________ _____________ $________
_____________ ________________________ _____________ $________
_____________ ________________________ _____________ $________
Abundance Donation *(see Details page for more info) $________
Total $________
Payment Method Direct Online Cheque Physical Deposit at Bank Cash at Gate
Database Details – In order to let you know about Get-togethers in your local area please indicate
your nearest town/city: ____________________________
Phone: ____________________ Cellphone ________________________
Email: ______________________________________________________
Food Requirements – meals are vegetarian if you have specific requirements please include them here:
Ticket Enquires: Phone Ami (03) 741 1538