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Haas Waikato Executive Leadership Programme


Register for the conference

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Personal Details

Title *
First Name *
Last Name *
Preferred Name
(for Name Tag)

Organisation Information
Title
Institution/Organisation
Position
Organisation Address
Suburb
City
Region/State
Post/Zip Code
Country
Telephone (work)
Fax (work)
Email *
Company Website

Mailing Address
Same as Above
Address Line
Suburb
City
Postcode

Contact Information

Home Phone
Mobile Phone
Preferred Phone Contact Home Number Office Number Mobile
Home Email
Preferred Email Address Work Home
Preferred Phone Contact
 

Special Dietary Requirements

Meal Requirements Vegetarian Vegan Gluten Free No Shellfish
Other Dietary Concerns
   

Information for the Haas Waikato Executive Leaders' Programme Admissions' Committee

Confidential: The information you provide below is for use by the Haas Waikato Executive Leaders' Programme Admissions' Committee Only
Annual Sales:  
 
Number of Employees:  
How many employees are under your direct supervision?  
How many reporting levels are above you, including the CEO of the parent company?  
What is the title of the person to whom you report?  

Activity

On Tuesday 15 May there will be an opportunity to play one game of 9 hole golf OR go on a sightseeing tour.
Please indicate which you wish to partake in
Golf Sightseeing
Please include your golf handicap if you wish to play golf
Note: If you wish to play golf please bring sneakers or golf shoes. A collared shirt is a standard rule for this golf course.

Other Information

Have you attended any other senior leadership programmes? (please name programme and location)
How did you learn about the Haas Waikato Executive Leadership Programme?
Is your Wife/Partner attending?   Please note that accommodation, meals and any other expenses associated with your wife/partner attending must be paid separately.
Yes No
Also include a paragraph about yourself which we would like to include as part of the conference material to other attendees.
Please tick here to confirm you are happy for us to include your above contact details.

Registrant Rates
NZD$11250 + GST
To secure a place a deposit of 25% of the programme fee NZD$2812.00 + GST should accompany your registration form. The remainder of the fee must be paid, in full, by Friday 30th March 2012
   
Cost Calculator $NZD 0

Payment:

I will pay by Direct Credit
Bank: ASB Bank Limited
Address: 500 Victoria St, Hamilton, New Zealand
Account Name: University of Waikato
Account Number: 12-3122-0084728-00
Swift Number: ASBBNZ2A
Reference: Haas Waikato Executive Leadership Programme 2012 [delegate name]

I will pay by Purchase Order

Please send your Purchase Order (approved, signed and dated) to:
Colleen Molloy on colleens@waikato.ac.nz
-or-
Fax to the attention of: Colleen Molloy +64 7 838 4675

Purchase Order address:
Attn: Colleen Molloy, Administration Manager
Centre for Corporate & Executive Education
Waikato Management School
The University of Waikato
Private Bag 3105
Hamilton 3240, New Zealand

I will pay by credit card (secured online payment)

ASB Online Secure Payment

Cancellation Policy:

In the event you are unable to attend the programme following payment you may nominate a colleague to attend on your behalf; you must notify us, in writing, at the below address, or by way of email to Leigh Taylor ltaylor@waikato.ac.nz.

Haas Waikato Executive Leadership Programme 2012
Centre for Corporate and Executive Education
Waikato Management School
University of Waikato
Private Bag 3105
Hillcrest Road
Hamilton 3240
New Zealand

Attention: Leigh Taylor

Contacts

Ph: (064) 0800 800 891

Peter SunDr Peter Sun
(64) 27 588 7728
petersun@waikato.ac.nz

 

Andrew Buchanan Smart
Andrew Buchanan-Smart (64) 27 658 4013
andrewbs@waikato.ac.nz