~ Maori Visitors Portal ~ Registration Form

AfterDark DESIGN i3MEDIA interactive...innovative...internet	Please enter form details below: GST Rate is 15% in New Zealand. All Prices are in $NZ and exclude GST.
Organisation Name:
Please attach any EVENT information(optional):	To Attach files Click here
Nickname:	For Email:(nickname@theblackpages.co.nz)
Name:*
Surname:*
Address:
Country:
Country(If Other Selected):
Phone:*
Mobile:
Fax:
Email:*
Advertise Event:	No Advertising required (at the moment) 1. $60 - 1 page advert - (200-300 words approx & 1 image) - Require 2 weeks notice for Ad\Event - Advertised for 2 weeks (only) 2. $85 - 1 page advert - (200-300 words approx & 1 image) - Require 1 month notice for Ad\Event - Advertised for 1 month (only) 3. $250 - 1 page advert - (200-300 words approx & 1 image) - Require 1 month notice for Ad\Event - Advertised for 3 months changed monthly 4. $500 - 1 page advert - (200-300 words approx & 1 image) - Require 1 month notice for Ad\Event - Advertised for 6 months changed monthly 5. $850 - 1 page advert - (200-300 words approx & 1 image) - Require 1 month notice for Ad\Event - Advertised for 12 months changed monthly * Advertise your Event\Newsletter\Panui of your Service.
Event Date :
Event Name :
Event Photo:	To Attach files Click here
Event Description:
Event Price:	* NZ$
Comment (Any further details):
DAYS TO GO: NZ's BIGGEST RUGBY EVENT 2011:
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