PMA Conference 2017 – Registration Pacific Health Realities: The Way Forward 27 – 29 September 2017, New Caledonia. Title*Mr.Mrs.Ms.Miss.Dr.Lord.Lady.Hon.Prof.First Name*Last Name*Company*Position*Email* Contact Number (with area code)*Location* AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country Optional Would you like us to send email updates on future PMA Conferences and Events? Would you like to receive the Associations quarterly newsletter? Would you like to receive PMA Membership information? Type of Registration*PMA Financial Member incl. 3 Days of Conference, 1 Welcome Cocktail Ticket, 1 Conference Dinner Ticket $600.00Non-Financial Member Registration incl. 3 Days of Conference, 1 Welcome Cocktail Ticket, 1 Conference Dinner Ticket $700.00Day Registration Only $250.00Select your registration type (prices in NZD)FunctionsYou may purchase extra tickets for our conference functions here. If you wish to purchase a table (10 seats) at the Conference Dinner please contact us directly and we will organise this for you.Conference Dinner Ticket Price: $ 200.00 QuantityPlease enter a value between 1 and 5.Welcome Cocktail Ticket Price: $ 160.00 QuantityPlease enter a value between 1 and 5.PaymentA receipt of payment will be emailed to you once payment is received. Registration Cancellation and Refund Policy . You must contact us no later than August 24, 2017 to cancel your registration for the Pasifika Medical Association and Pacific Community (SPC) Conference 2017. For cancellations made by August 24, 2017 your registration fee will be refunded less a $100.00 cancellation fee. Any cancellations made after this date will not be refunded.Total $ 0.00 Do you need an invoice?*YesNoCompany to be invoicedBilling address for invoice Street Address Address Line 2 City ZIP / Postal Code