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<title>Bali Meeting - Online Registration</title>






<form method="POST" action="http://www.garnerpark.com/cgi-bin/BFormMail.pl">

<input type=hidden name="recipient" value="nickw@bcs.net.nz">
<input type=hidden name="subject" value="Bali Meeting Registration">
<input type=hidden name="required" value="email,realname,Organisation">
 <input type=hidden name="print_config" value="email,realname,Title,Organisation,Country,Phone,Details">
<input type=hidden name="title" value="APTLD Registration Information">
<input type=hidden name="return_link_url" value="http://www.aptld.org">
<input type=hidden name="return_link_title" value="Back to APTLD Main Page">
<input type=hidden name="cc_visitor" value="1">
<input type=hidden name="courtesy_reply" value="yes">
<input type=hidden name="courtesy_reply_texta" value="Thank you for your registration for the APTLD Bali meeting, 27 February 2007.">
<input type=hidden name="courtesy_reply_textb" value="If you have any further enquiries, or would like to correct any mistakes that you may have submitted in your registration form, please contact sec@aptld.org or phone +64-4-495-2119.">

<input type=hidden name="courtesy_who_we_are" value="APTLD Secretariat">

<table><tr><td valign="middle"><img src="/img/tit02_1.gif" width="37" height="44"></td>
<td valign="middle"><font class="tit">Pre-Registration for APTLD Meeting</font></td><td valign="middle"><img src="/img/tit02_2.gif" width="196" height="44"></td></tr></table>


<p>Bali Members and Board Meeting </p>
<p>27 February 2007</p>

<p>Please use this form to register your attendance at APTLD's next meeting. The Secretariat will contact you after you register, to confirm your registration. </p>
     <p>&nbsp;</p>
     <p>If you are interested in attending this meeting but not yet an APTLD Member, please use this same form.  We will contact you to confirm your interest.</p>
     <p>&nbsp;</p>

 
     
     
<h3>Registration Details</h3>

<table><tr>
<td align="right">Title: </td>
   <td colspan=3 align="left"><INPUT TYPE="TEXT" SIZE="30" NAME="Title"></td>
 </tr>
 <tr>
  <td align="right">Name:</td>
  <td colspan=3 align="left">
  <INPUT TYPE="TEXT" SIZE="30" NAME="realname">
  </td>
 </tr>
 <tr>
  <td align="right">Organisation:</td>
  <td colspan=3 align="left">
  <INPUT TYPE="TEXT" SIZE="50" NAME="Organisation">
  </td>
 </tr>
 <tr>
  <td align="right">Country:</td>
  <td colspan=3 align="left">
 <INPUT TYPE="TEXT" SIZE="15" NAME="Country">
  </td>
 </tr>
 <tr>
   <td align="right">Email Address:</td>
   <td colspan=3 align="left">
   <INPUT TYPE="TEXT" SIZE="30" NAME="email">
  </td>
 </tr>
 <tr>
  <td align="right">Phone number:</td>
  <td colspan=3 align="left">
<INPUT TYPE="TEXT" SIZE="30" NAME="Phone">
  </td>
 </tr>
 <tr>
   <td align="right">Arrival Details<br>(Please let us know your arrival date/time)</td>
   <td colspan=3 align="left"><TEXTAREA ROWS="8" COLUMNS="60" NAME="Details">  </textarea>
     </td>
 </tr>


</table>

<p><input value="Send Information" type="submit">
  <input value="Clear" form="" fields="" type="reset"></p>


</form>