School of Medicine Online registration

Please contact us if you need assistance. If you are paying by credit card, please visit our ecommerce site.

Items marked with a red asterisk (*) are required to be completed. Although other fields are optional, they will assist us in processing your applications quickly and accurately.

Personal information

Title:
* First Name:
* Last Name:
Prefered Name:
* Position:
* Specialty:
Current Department:

Contact details

* Address:
* City:
Post/ZIP Code:	Please visit www.nzpost.co.nz if you are unsure of your postcode.
Country:
Home Phone:
Work Phone:	extension:
* Mobile:
* Email:
Practice or Midwife License Number:

Special requirements

Some of our course content is delivered on the top floor accessible only via stairs. Will this be a problem?

Do you have any special dietary requirements?

Select your course

Course Name:
Method of Payments:	Cheques Direct Debit
	Cheques are payable to The University Of Auckland Postal address: The Advanced Clinical Skills Centre Private Bag 92019 Auckland 1142
* Date of Course:
Have you attended a course here?