"video conference bookings"

BOOKING INSTRUCTIONS
Before proceeding, click here for instructions on how to complete the Video Conference Booking Form. Fields marked with an asterisk* are necessary to complete your booking.

PLEASE NOTE >> This booking form is only required to be completed if 3 or more Vivid sites are required to participate, or if you are requiring a connection with a site not on the Vivid network.  Please remember to include your own site on this booking form.  A minimum of 24 hours notice is required for bookings that have only Vivid sites participating.  A minimum of 48 hours notice is required for bookings that include non Vivid sites within New Zealand or Australia.  A minimum of 1 week notice is required for bookings that include non Vivid sites with a large time difference between countries, such as UK, Canada and USA etc.  Costs are involved in any connection with a non Vivid site.

Conference Title *
Conference Type *	Single/One-off Conference Recurring Conference
Conference Dates *	March 2010 M T W T F S S 22 23 24 25 26 27 28 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1 2 3 4
Conference Start Time *	Hour: 1 2 3 4 5 6 7 8 9 10 11 12
	Minute: 00 05 10 15 20 25 30 35 40 45 50 55
	AM/PM: am pm
Conference Finish Time *	Hour: 1 2 3 4 5 6 7 8 9 10 11 12
	Minute: 00 05 10 15 20 25 30 35 40 45 50 55
	AM/PM: am pm
Recurring Conference only (please list all appropriate dates)
ORGANISER DETAILS
Full Name *
Organisation *
Address *
Phone *
Email *
CONFERENCE OPTIONS
Layout	Select: Full Screen Split Screen Auto
Split Screen	Select: Default 2 Split Screen 3 Split Screen 4 Split Screen 5 Split Screen
PowerPoint Presentation	Select: Yes No
TELEPAEDS SITES
Site Name 1	Select: ADHB CEC [Clinical Education Centre] ADHB Rangitoto Room [LabsPlus] Ashburton [Community Mental Health] AUT Midwifery Buller [Hospital] Canterbury Labs Carers New Zealand Central Otago Mental Health CLYDE [Dunstan Hospital] Christchurch CHOC Canterbury DHB Corporate Office Christchurch Echoscan 3000 Christchurch Parkside Training Room Christchurch Paeds Christchurch POSG Christchurch School of Medicine Clutha Community Health CMDHB Board Office CMDHB Kidz First Rm1 CMDHB Manukau Super Clinic CMDHB Staff Centre Cystic Fibrosis NZ Dunedin Hospital Funding & Planning Dunedin Mental Health EPS Dunedin Oncology Conference Room Dunedin Paeds Fiordland Community Health Centre [Te Anau Health Centre] Gisborne Hospital Gore Hospital Gore MHU Greenlane Quality Conference Room Greymouth Boardroom Greymouth Lecture Theatre Greymouth Mental Health Hawera Hospital HBDHB Education Centre [Hastings] HBDHB Lab Seminar Room [Hastings] Hillmorton [Hospital] Hillmorton Medlicott Room Hokitika [Health Centre] Hutt Valley Paeds Invercargill Community House Invercargill Governance [Southland Hospital] Invercargill Hospital Management [Southland Hospital] Invercargill Matai Room [Southland Hospital] Invercargill Paeds [Southland Hospital] Invercargill Primary Health Organisation KidzFirst [Middlemore Hospital] Life Unlimited Hamilton Life Unlimited Wellington Medsafe VC1 MidCentral Child Health MidCentral Clinical Library MoH 133 Molesworth VC1 MoH 133 Molesworth VC2 MoH 180 Molesworth VC1 MoH Dunedin VC1 MoH Hamilton VC1 MoH Hereford VC1 MoH KM House VC1 MoH Oxford VC1 MoH Penrose VC1 MoH Penrose VC2 MoH Terrace VC1 MoH Terrace VC2 MoH Terrace VC3 MoH Terrace VC4 MoH Wanganui VC1 Nelson Acute [Mental Health Unit] Nelson Bays Primary Health Nelson DHB [Office Meeting Room] Nelson Paeds Nelson Seminar Centre Northern DHB Support Agency Northern Southland College [Lumsden] NDHB Bay of Islands Hospital NDHB Dargaville Hospital NDHB Kaitaia Hospital NDHB Maternity NDHB Northland Breast Screening NDHB Northland DHB [Whangarei] NDHB Whangarei 2nd Floor Conf Rm NDHB Whangarei Mental Health NDHB Whangarei Paeds Oamaru [Waitaki Mental Health] Otago DCH [Child Health] Otago District Health Board [Dunedin Hospital] Parent to Parent Auckland Parent to Parent Central Lakes [Rotorua] Parent to Parent Christchurch Parent to Parent Coastal Bay of Plenty [Tauranga] Parent to Parent Dunedin Parent to Parent Manawatu [Palmerston North] Parent to Parent National [Hamilton] Parent to Parent Nelson Parent to Parent Southland [Invercargill] Parent to Parent Wellington Princess Margaret Hospital Reefton Rotorua Child Health Rotorua Mental Health Rotorua - Te Au O Hinetai Schizophrenia Fellowship New Zealand SISSAL Admin Starship Paeds Cardiology Starship POSG Starship Puawaitahi Starship VC Room [Level 3, Room 3.106] Taranaki Corp MR 1 Taranaki Corp MR 3 Taranaki Education Centre Rm1 Taranaki Education Centre Rm5 Taranaki Paeds [New Plymouth] Taupo Mental Health Tauranga Hospital TeleMidWifery Christchurch TelePaeds Network Admin Timaru Hospital Timaru MHU [Mental Heaalth Unit] Turangi Community Health Centre UoA School of Population Health Waikato Hospital Hockin Waikato Hospital Paeds Wairau Kimi Hauora Wairau Mental Health Wairau Support Services 1 Wairau Support Services 3 Waitemata Breast Screening Waitemata Helensville CMHT Waitemata NSH Lower Ground [North Shore Hospital] Waitemata NSH Tower [North Shore Hospital] Waitemata Red Beach CMHT [Whangaparoa] Waitemata Te Atarau Inpatient Unit Waitemata Tohu Wairua CMHT [Warkworth] Waitemata Waimarino Building Waitemata Waimarire Taharoto Road Waitamata Waitakere ECC Waitemata Waitakere Woodford House Wakari Hospital Wakatipu Community Mental Health Wanganui Paeds Wellington Clinical Services Block Wellington Paeds Wellington POSG Whakatane Hospital OTHER
Site Name 2	Select: ADHB CEC [Clinical Education Centre] ADHB Rangitoto Room [LabsPlus] Ashburton [Community Mental Health] AUT Midwifery Buller [Hospital] Canterbury Labs Carers New Zealand Central Otago Mental Health CLYDE [Dunstan Hospital] Christchurch CHOC Canterbury DHB Corporate Office Christchurch Echoscan 3000 Christchurch Parkside Training Room Christchurch Paeds Christchurch POSG Christchurch School of Medicine Clutha Community Health CMDHB Board Office CMDHB Kidz First Rm1 CMDHB Manukau Super Clinic CMDHB Staff Centre Cystic Fibrosis NZ Dunedin Hospital Funding & Planning Dunedin Mental Health EPS Dunedin Oncology Conference Room Dunedin Paeds Fiordland Community Health Centre [Te Anau Health Centre] Gisborne Hospital Gore Hospital Gore MHU Greenlane Quality Conference Room Greymouth Boardroom Greymouth Lecture Theatre Greymouth Mental Health Hawera Hospital HBDHB Education Centre [Hastings] HBDHB Lab Seminar Room [Hastings] Hillmorton [Hospital] Hillmorton Medlicott Room Hokitika [Health Centre] Hutt Valley Paeds Invercargill Community House Invercargill Governance [Southland Hospital] Invercargill Hospital Management [Southland Hospital] Invercargill Matai Room [Southland Hospital] Invercargill Paeds [Southland Hospital] Invercargill Primary Health Organisation KidzFirst [Middlemore Hospital] Life Unlimited Hamilton Life Unlimited Wellington Medsafe VC1 MidCentral Child Health MidCentral Clinical Library MoH 133 Molesworth VC1 MoH 133 Molesworth VC2 MoH 180 Molesworth VC1 MoH Dunedin VC1 MoH Hamilton VC1 MoH Hereford VC1 MoH KM House VC1 MoH Oxford VC1 MoH Penrose VC1 MoH Penrose VC2 MoH Terrace VC1 MoH Terrace VC2 MoH Terrace VC3 MoH Terrace VC4 MoH Wanganui VC1 Nelson Acute [Mental Health Unit] Nelson Bays Primary Health Nelson DHB [Office Meeting Room] Nelson Paeds Nelson Seminar Centre Northern DHB Support Agency Northern Southland College [Lumsden] NDHB Bay of Islands Hospital NDHB Dargaville Hospital NDHB Kaitaia Hospital NDHB Maternity NDHB Northland Breast Screening NDHB Northland DHB [Whangarei] NDHB Whangarei 2nd Floor Conf Rm NDHB Whangarei Mental Health NDHB Whangarei Paeds Oamaru [Waitaki Mental Health] Otago DCH [Child Health] Otago District Health Board [Dunedin Hospital] Parent to Parent Auckland Parent to Parent Central Lakes [Rotorua] Parent to Parent Christchurch Parent to Parent Coastal Bay of Plenty [Tauranga] Parent to Parent Dunedin Parent to Parent Manawatu [Palmerston North] Parent to Parent National [Hamilton] Parent to Parent Nelson Parent to Parent Southland [Invercargill] Parent to Parent Wellington Princess Margaret Hospital Reefton Rotorua Child Health Rotorua Mental Health Rotorua - Te Au O Hinetai Schizophrenia Fellowship New Zealand SISSAL Admin Starship Paeds Cardiology Starship POSG Starship Puawaitahi Starship VC Room [Level 3, Room 3.106] Taranaki Corp MR 1 Taranaki Corp MR 3 Taranaki Education Centre Rm1 Taranaki Education Centre Rm5 Taranaki Paeds [New Plymouth] Taupo Mental Health Tauranga Hospital TeleMidWifery Christchurch TelePaeds Network Admin Timaru Hospital Timaru MHU [Mental Heaalth Unit] Turangi Community Health Centre UoA School of Population Health Waikato Hospital Hockin Waikato Hospital Paeds Wairau Kimi Hauora Wairau Mental Health Wairau Support Services 1 Wairau Support Services 3 Waitemata Breast Screening Waitemata Helensville CMHT Waitemata NSH Lower Ground [North Shore Hospital] Waitemata NSH Tower [North Shore Hospital] Waitemata Red Beach CMHT [Whangaparoa] Waitemata Te Atarau Inpatient Unit Waitemata Tohu Wairua CMHT [Warkworth] Waitemata Waimarino Building Waitemata Waimarire Taharoto Road Waitamata Waitakere ECC Waitemata Waitakere Woodford House Wakari Hospital Wakatipu Community Mental Health Wanganui Paeds Wellington Clinical Services Block Wellington Paeds Wellington POSG Whakatane Hospital OTHER
Site Name 3	Select: ADHB CEC [Clinical Education Centre] ADHB Rangitoto Room [LabsPlus] Ashburton [Community Mental Health] AUT Midwifery Buller [Hospital] Canterbury Labs Carers New Zealand Central Otago Mental Health CLYDE [Dunstan Hospital] Christchurch CHOC Canterbury DHB Corporate Office Christchurch Echoscan 3000 Christchurch Parkside Training Room Christchurch Paeds Christchurch POSG Christchurch School of Medicine Clutha Community Health CMDHB Board Office CMDHB Kidz First Rm1 CMDHB Manukau Super Clinic CMDHB Staff Centre Cystic Fibrosis NZ Dunedin Hospital Funding & Planning Dunedin Mental Health EPS Dunedin Oncology Conference Room Dunedin Paeds Fiordland Community Health Centre [Te Anau Health Centre] Gisborne Hospital Gore Hospital Gore MHU Greenlane Quality Conference Room Greymouth Boardroom Greymouth Lecture Theatre Greymouth Mental Health Hawera Hospital HBDHB Education Centre [Hastings] HBDHB Lab Seminar Room [Hastings] Hillmorton [Hospital] Hillmorton Medlicott Room Hokitika [Health Centre] Hutt Valley Paeds Invercargill Community House Invercargill Governance [Southland Hospital] Invercargill Hospital Management [Southland Hospital] Invercargill Matai Room [Southland Hospital] Invercargill Paeds [Southland Hospital] Invercargill Primary Health Organisation KidzFirst [Middlemore Hospital] Life Unlimited Hamilton Life Unlimited Wellington Medsafe VC1 MidCentral Child Health MidCentral Clinical Library MoH 133 Molesworth VC1 MoH 133 Molesworth VC2 MoH 180 Molesworth VC1 MoH Dunedin VC1 MoH Hamilton VC1 MoH Hereford VC1 MoH KM House VC1 MoH Oxford VC1 MoH Penrose VC1 MoH Penrose VC2 MoH Terrace VC1 MoH Terrace VC2 MoH Terrace VC3 MoH Terrace VC4 MoH Wanganui VC1 Nelson Acute [Mental Health Unit] Nelson Bays Primary Health Nelson DHB [Office Meeting Room] Nelson Paeds Nelson Seminar Centre Northern DHB Support Agency Northern Southland College [Lumsden] NDHB Bay of Islands Hospital NDHB Dargaville Hospital NDHB Kaitaia Hospital NDHB Maternity NDHB Northland Breast Screening NDHB Northland DHB [Whangarei] NDHB Whangarei 2nd Floor Conf Rm NDHB Whangarei Mental Health NDHB Whangarei Paeds Oamaru [Waitaki Mental Health] Otago DCH [Child Health] Otago District Health Board [Dunedin Hospital] Parent to Parent Auckland Parent to Parent Central Lakes [Rotorua] Parent to Parent Christchurch Parent to Parent Coastal Bay of Plenty [Tauranga] Parent to Parent Dunedin Parent to Parent Manawatu [Palmerston North] Parent to Parent National [Hamilton] Parent to Parent Nelson Parent to Parent Southland [Invercargill] Parent to Parent Wellington Princess Margaret Hospital Reefton Rotorua Child Health Rotorua Mental Health Rotorua - Te Au O Hinetai Schizophrenia Fellowship New Zealand SISSAL Admin Starship Paeds Cardiology Starship POSG Starship Puawaitahi Starship VC Room [Level 3, Room 3.106] Taranaki Corp MR 1 Taranaki Corp MR 3 Taranaki Education Centre Rm1 Taranaki Education Centre Rm5 Taranaki Paeds [New Plymouth] Taupo Mental Health Tauranga Hospital TeleMidWifery Christchurch TelePaeds Network Admin Timaru Hospital Timaru MHU [Mental Heaalth Unit] Turangi Community Health Centre UoA School of Population Health Waikato Hospital Hockin Waikato Hospital Paeds Wairau Kimi Hauora Wairau Mental Health Wairau Support Services 1 Wairau Support Services 3 Waitemata Breast Screening Waitemata Helensville CMHT Waitemata NSH Lower Ground [North Shore Hospital] Waitemata NSH Tower [North Shore Hospital] Waitemata Red Beach CMHT [Whangaparoa] Waitemata Te Atarau Inpatient Unit Waitemata Tohu Wairua CMHT [Warkworth] Waitemata Waimarino Building Waitemata Waimarire Taharoto Road Waitamata Waitakere ECC Waitemata Waitakere Woodford House Wakari Hospital Wakatipu Community Mental Health Wanganui Paeds Wellington Clinical Services Block Wellington Paeds Wellington POSG Whakatane Hospital OTHER
Site Name 4	Select: ADHB CEC [Clinical Education Centre] ADHB Rangitoto Room [LabsPlus] Ashburton [Community Mental Health] AUT Midwifery Buller [Hospital] Canterbury Labs Carers New Zealand Central Otago Mental Health CLYDE [Dunstan Hospital] Christchurch CHOC Canterbury DHB Corporate Office Christchurch Echoscan 3000 Christchurch Parkside Training Room Christchurch Paeds Christchurch POSG Christchurch School of Medicine Clutha Community Health CMDHB Board Office CMDHB Kidz First Rm1 CMDHB Manukau Super Clinic CMDHB Staff Centre Cystic Fibrosis NZ Dunedin Hospital Funding & Planning Dunedin Mental Health EPS Dunedin Oncology Conference Room Dunedin Paeds Fiordland Community Health Centre [Te Anau Health Centre] Gisborne Hospital Gore Hospital Gore MHU Greenlane Quality Conference Room Greymouth Boardroom Greymouth Lecture Theatre Greymouth Mental Health Hawera Hospital HBDHB Education Centre [Hastings] HBDHB Lab Seminar Room [Hastings] Hillmorton [Hospital] Hillmorton Medlicott Room Hokitika [Health Centre] Hutt Valley Paeds Invercargill Community House Invercargill Governance [Southland Hospital] Invercargill Hospital Management [Southland Hospital] Invercargill Matai Room [Southland Hospital] Invercargill Paeds [Southland Hospital] Invercargill Primary Health Organisation KidzFirst [Middlemore Hospital] Life Unlimited Hamilton Life Unlimited Wellington Medsafe VC1 MidCentral Child Health MidCentral Clinical Library MoH 133 Molesworth VC1 MoH 133 Molesworth VC2 MoH 180 Molesworth VC1 MoH Dunedin VC1 MoH Hamilton VC1 MoH Hereford VC1 MoH KM House VC1 MoH Oxford VC1 MoH Penrose VC1 MoH Penrose VC2 MoH Terrace VC1 MoH Terrace VC2 MoH Terrace VC3 MoH Terrace VC4 MoH Wanganui VC1 Nelson Acute [Mental Health Unit] Nelson Bays Primary Health Nelson DHB [Office Meeting Room] Nelson Paeds Nelson Seminar Centre Northern DHB Support Agency Northern Southland College [Lumsden] NDHB Bay of Islands Hospital NDHB Dargaville Hospital NDHB Kaitaia Hospital NDHB Maternity NDHB Northland Breast Screening NDHB Northland DHB [Whangarei] NDHB Whangarei 2nd Floor Conf Rm NDHB Whangarei Mental Health NDHB Whangarei Paeds Oamaru [Waitaki Mental Health] Otago DCH [Child Health] Otago District Health Board [Dunedin Hospital] Parent to Parent Auckland Parent to Parent Central Lakes [Rotorua] Parent to Parent Christchurch Parent to Parent Coastal Bay of Plenty [Tauranga] Parent to Parent Dunedin Parent to Parent Manawatu [Palmerston North] Parent to Parent National [Hamilton] Parent to Parent Nelson Parent to Parent Southland [Invercargill] Parent to Parent Wellington Princess Margaret Hospital Reefton Rotorua Child Health Rotorua Mental Health Rotorua - Te Au O Hinetai Schizophrenia Fellowship New Zealand SISSAL Admin Starship Paeds Cardiology Starship POSG Starship Puawaitahi Starship VC Room [Level 3, Room 3.106] Taranaki Corp MR 1 Taranaki Corp MR 3 Taranaki Education Centre Rm1 Taranaki Education Centre Rm5 Taranaki Paeds [New Plymouth] Taupo Mental Health Tauranga Hospital TeleMidWifery Christchurch TelePaeds Network Admin Timaru Hospital Timaru MHU [Mental Heaalth Unit] Turangi Community Health Centre UoA School of Population Health Waikato Hospital Hockin Waikato Hospital Paeds Wairau Kimi Hauora Wairau Mental Health Wairau Support Services 1 Wairau Support Services 3 Waitemata Breast Screening Waitemata Helensville CMHT Waitemata NSH Lower Ground [North Shore Hospital] Waitemata NSH Tower [North Shore Hospital] Waitemata Red Beach CMHT [Whangaparoa] Waitemata Te Atarau Inpatient Unit Waitemata Tohu Wairua CMHT [Warkworth] Waitemata Waimarino Building Waitemata Waimarire Taharoto Road Waitamata Waitakere ECC Waitemata Waitakere Woodford House Wakari Hospital Wakatipu Community Mental Health Wanganui Paeds Wellington Clinical Services Block Wellington Paeds Wellington POSG Whakatane Hospital OTHER
Site Name 5	Select: ADHB CEC [Clinical Education Centre] ADHB Rangitoto Room [LabsPlus] Ashburton [Community Mental Health] AUT Midwifery Buller [Hospital] Canterbury Labs Carers New Zealand Central Otago Mental Health CLYDE [Dunstan Hospital] Christchurch CHOC Canterbury DHB Corporate Office Christchurch Echoscan 3000 Christchurch Parkside Training Room Christchurch Paeds Christchurch POSG Christchurch School of Medicine Clutha Community Health CMDHB Board Office CMDHB Kidz First Rm1 CMDHB Manukau Super Clinic CMDHB Staff Centre Cystic Fibrosis NZ Dunedin Hospital Funding & Planning Dunedin Mental Health EPS Dunedin Oncology Conference Room Dunedin Paeds Fiordland Community Health Centre [Te Anau Health Centre] Gisborne Hospital Gore Hospital Gore MHU Greenlane Quality Conference Room Greymouth Boardroom Greymouth Lecture Theatre Greymouth Mental Health Hawera Hospital HBDHB Education Centre [Hastings] HBDHB Lab Seminar Room [Hastings] Hillmorton [Hospital] Hillmorton Medlicott Room Hokitika [Health Centre] Hutt Valley Paeds Invercargill Community House Invercargill Governance [Southland Hospital] Invercargill Hospital Management [Southland Hospital] Invercargill Matai Room [Southland Hospital] Invercargill Paeds [Southland Hospital] Invercargill Primary Health Organisation KidzFirst [Middlemore Hospital] Life Unlimited Hamilton Life Unlimited Wellington Medsafe VC1 MidCentral Child Health MidCentral Clinical Library MoH 133 Molesworth VC1 MoH 133 Molesworth VC2 MoH 180 Molesworth VC1 MoH Dunedin VC1 MoH Hamilton VC1 MoH Hereford VC1 MoH KM House VC1 MoH Oxford VC1 MoH Penrose VC1 MoH Penrose VC2 MoH Terrace VC1 MoH Terrace VC2 MoH Terrace VC3 MoH Terrace VC4 MoH Wanganui VC1 Nelson Acute [Mental Health Unit] Nelson Bays Primary Health Nelson DHB [Office Meeting Room] Nelson Paeds Nelson Seminar Centre Northern DHB Support Agency Northern Southland College [Lumsden] NDHB Bay of Islands Hospital NDHB Dargaville Hospital NDHB Kaitaia Hospital NDHB Maternity NDHB Northland Breast Screening NDHB Northland DHB [Whangarei] NDHB Whangarei 2nd Floor Conf Rm NDHB Whangarei Mental Health NDHB Whangarei Paeds Oamaru [Waitaki Mental Health] Otago DCH [Child Health] Otago District Health Board [Dunedin Hospital] Parent to Parent Auckland Parent to Parent Central Lakes [Rotorua] Parent to Parent Christchurch Parent to Parent Coastal Bay of Plenty [Tauranga] Parent to Parent Dunedin Parent to Parent Manawatu [Palmerston North] Parent to Parent National [Hamilton] Parent to Parent Nelson Parent to Parent Southland [Invercargill] Parent to Parent Wellington Princess Margaret Hospital Reefton Rotorua Child Health Rotorua Mental Health Rotorua - Te Au O Hinetai Schizophrenia Fellowship New Zealand SISSAL Admin Starship Paeds Cardiology Starship POSG Starship Puawaitahi Starship VC Room [Level 3, Room 3.106] Taranaki Corp MR 1 Taranaki Corp MR 3 Taranaki Education Centre Rm1 Taranaki Education Centre Rm5 Taranaki Paeds [New Plymouth] Taupo Mental Health Tauranga Hospital TeleMidWifery Christchurch TelePaeds Network Admin Timaru Hospital Timaru MHU [Mental Heaalth Unit] Turangi Community Health Centre UoA School of Population Health Waikato Hospital Hockin Waikato Hospital Paeds Wairau Kimi Hauora Wairau Mental Health Wairau Support Services 1 Wairau Support Services 3 Waitemata Breast Screening Waitemata Helensville CMHT Waitemata NSH Lower Ground [North Shore Hospital] Waitemata NSH Tower [North Shore Hospital] Waitemata Red Beach CMHT [Whangaparoa] Waitemata Te Atarau Inpatient Unit Waitemata Tohu Wairua CMHT [Warkworth] Waitemata Waimarino Building Waitemata Waimarire Taharoto Road Waitamata Waitakere ECC Waitemata Waitakere Woodford House Wakari Hospital Wakatipu Community Mental Health Wanganui Paeds Wellington Clinical Services Block Wellington Paeds Wellington POSG Whakatane Hospital OTHER
Site Name 6	Select: ADHB CEC [Clinical Education Centre] ADHB Rangitoto Room [LabsPlus] Ashburton [Community Mental Health] AUT Midwifery Buller [Hospital] Canterbury Labs Carers New Zealand Central Otago Mental Health CLYDE [Dunstan Hospital] Christchurch CHOC Canterbury DHB Corporate Office Christchurch Echoscan 3000 Christchurch Parkside Training Room Christchurch Paeds Christchurch POSG Christchurch School of Medicine Clutha Community Health CMDHB Board Office CMDHB Kidz First Rm1 CMDHB Manukau Super Clinic CMDHB Staff Centre Cystic Fibrosis NZ Dunedin Hospital Funding & Planning Dunedin Mental Health EPS Dunedin Oncology Conference Room Dunedin Paeds Fiordland Community Health Centre [Te Anau Health Centre] Gisborne Hospital Gore Hospital Gore MHU Greenlane Quality Conference Room Greymouth Boardroom Greymouth Lecture Theatre Greymouth Mental Health Hawera Hospital HBDHB Education Centre [Hastings] HBDHB Lab Seminar Room [Hastings] Hillmorton [Hospital] Hillmorton Medlicott Room Hokitika [Health Centre] Hutt Valley Paeds Invercargill Community House Invercargill Governance [Southland Hospital] Invercargill Hospital Management [Southland Hospital] Invercargill Matai Room [Southland Hospital] Invercargill Paeds [Southland Hospital] Invercargill Primary Health Organisation KidzFirst [Middlemore Hospital] Life Unlimited Hamilton Life Unlimited Wellington Medsafe VC1 MidCentral Child Health MidCentral Clinical Library MoH 133 Molesworth VC1 MoH 133 Molesworth VC2 MoH 180 Molesworth VC1 MoH Dunedin VC1 MoH Hamilton VC1 MoH Hereford VC1 MoH KM House VC1 MoH Oxford VC1 MoH Penrose VC1 MoH Penrose VC2 MoH Terrace VC1 MoH Terrace VC2 MoH Terrace VC3 MoH Terrace VC4 MoH Wanganui VC1 Nelson Acute [Mental Health Unit] Nelson Bays Primary Health Nelson DHB [Office Meeting Room] Nelson Paeds Nelson Seminar Centre Northern DHB Support Agency Northern Southland College [Lumsden] NDHB Bay of Islands Hospital NDHB Dargaville Hospital NDHB Kaitaia Hospital NDHB Maternity NDHB Northland Breast Screening NDHB Northland DHB [Whangarei] NDHB Whangarei 2nd Floor Conf Rm NDHB Whangarei Mental Health NDHB Whangarei Paeds Oamaru [Waitaki Mental Health] Otago DCH [Child Health] Otago District Health Board [Dunedin Hospital] Parent to Parent Auckland Parent to Parent Central Lakes [Rotorua] Parent to Parent Christchurch Parent to Parent Coastal Bay of Plenty [Tauranga] Parent to Parent Dunedin Parent to Parent Manawatu [Palmerston North] Parent to Parent National [Hamilton] Parent to Parent Nelson Parent to Parent Southland [Invercargill] Parent to Parent Wellington Princess Margaret Hospital Reefton Rotorua Child Health Rotorua Mental Health Rotorua - Te Au O Hinetai Schizophrenia Fellowship New Zealand SISSAL Admin Starship Paeds Cardiology Starship POSG Starship Puawaitahi Starship VC Room [Level 3, Room 3.106] Taranaki Corp MR 1 Taranaki Corp MR 3 Taranaki Education Centre Rm1 Taranaki Education Centre Rm5 Taranaki Paeds [New Plymouth] Taupo Mental Health Tauranga Hospital TeleMidWifery Christchurch TelePaeds Network Admin Timaru Hospital Timaru MHU [Mental Heaalth Unit] Turangi Community Health Centre UoA School of Population Health Waikato Hospital Hockin Waikato Hospital Paeds Wairau Kimi Hauora Wairau Mental Health Wairau Support Services 1 Wairau Support Services 3 Waitemata Breast Screening Waitemata Helensville CMHT Waitemata NSH Lower Ground [North Shore Hospital] Waitemata NSH Tower [North Shore Hospital] Waitemata Red Beach CMHT [Whangaparoa] Waitemata Te Atarau Inpatient Unit Waitemata Tohu Wairua CMHT [Warkworth] Waitemata Waimarino Building Waitemata Waimarire Taharoto Road Waitamata Waitakere ECC Waitemata Waitakere Woodford House Wakari Hospital Wakatipu Community Mental Health Wanganui Paeds Wellington Clinical Services Block Wellington Paeds Wellington POSG Whakatane Hospital OTHER
Site Name 7	Select: ADHB CEC [Clinical Education Centre] ADHB Rangitoto Room [LabsPlus] Ashburton [Community Mental Health] AUT Midwifery Buller [Hospital] Canterbury Labs Carers New Zealand Central Otago Mental Health CLYDE [Dunstan Hospital] Christchurch CHOC Canterbury DHB Corporate Office Christchurch Echoscan 3000 Christchurch Parkside Training Room Christchurch Paeds Christchurch POSG Christchurch School of Medicine Clutha Community Health CMDHB Board Office CMDHB Kidz First Rm1 CMDHB Manukau Super Clinic CMDHB Staff Centre Cystic Fibrosis NZ Dunedin Hospital Funding & Planning Dunedin Mental Health EPS Dunedin Oncology Conference Room Dunedin Paeds Fiordland Community Health Centre [Te Anau Health Centre] Gisborne Hospital Gore Hospital Gore MHU Greenlane Quality Conference Room Greymouth Boardroom Greymouth Lecture Theatre Greymouth Mental Health Hawera Hospital HBDHB Education Centre [Hastings] HBDHB Lab Seminar Room [Hastings] Hillmorton [Hospital] Hillmorton Medlicott Room Hokitika [Health Centre] Hutt Valley Paeds Invercargill Community House Invercargill Governance [Southland Hospital] Invercargill Hospital Management [Southland Hospital] Invercargill Matai Room [Southland Hospital] Invercargill Paeds [Southland Hospital] Invercargill Primary Health Organisation KidzFirst [Middlemore Hospital] Life Unlimited Hamilton Life Unlimited Wellington Medsafe VC1 MidCentral Child Health MidCentral Clinical Library MoH 133 Molesworth VC1 MoH 133 Molesworth VC2 MoH 180 Molesworth VC1 MoH Dunedin VC1 MoH Hamilton VC1 MoH Hereford VC1 MoH KM House VC1 MoH Oxford VC1 MoH Penrose VC1 MoH Penrose VC2 MoH Terrace VC1 MoH Terrace VC2 MoH Terrace VC3 MoH Terrace VC4 MoH Wanganui VC1 Nelson Acute [Mental Health Unit] Nelson Bays Primary Health Nelson DHB [Office Meeting Room] Nelson Paeds Nelson Seminar Centre Northern DHB Support Agency Northern Southland College [Lumsden] NDHB Bay of Islands Hospital NDHB Dargaville Hospital NDHB Kaitaia Hospital NDHB Maternity NDHB Northland Breast Screening NDHB Northland DHB [Whangarei] NDHB Whangarei 2nd Floor Conf Rm NDHB Whangarei Mental Health NDHB Whangarei Paeds Oamaru [Waitaki Mental Health] Otago DCH [Child Health] Otago District Health Board [Dunedin Hospital] Parent to Parent Auckland Parent to Parent Central Lakes [Rotorua] Parent to Parent Christchurch Parent to Parent Coastal Bay of Plenty [Tauranga] Parent to Parent Dunedin Parent to Parent Manawatu [Palmerston North] Parent to Parent National [Hamilton] Parent to Parent Nelson Parent to Parent Southland [Invercargill] Parent to Parent Wellington Princess Margaret Hospital Reefton Rotorua Child Health Rotorua Mental Health Rotorua - Te Au O Hinetai Schizophrenia Fellowship New Zealand SISSAL Admin Starship Paeds Cardiology Starship POSG Starship Puawaitahi Starship VC Room [Level 3, Room 3.106] Taranaki Corp MR 1 Taranaki Corp MR 3 Taranaki Education Centre Rm1 Taranaki Education Centre Rm5 Taranaki Paeds [New Plymouth] Taupo Mental Health Tauranga Hospital TeleMidWifery Christchurch TelePaeds Network Admin Timaru Hospital Timaru MHU [Mental Heaalth Unit] Turangi Community Health Centre UoA School of Population Health Waikato Hospital Hockin Waikato Hospital Paeds Wairau Kimi Hauora Wairau Mental Health Wairau Support Services 1 Wairau Support Services 3 Waitemata Breast Screening Waitemata Helensville CMHT Waitemata NSH Lower Ground [North Shore Hospital] Waitemata NSH Tower [North Shore Hospital] Waitemata Red Beach CMHT [Whangaparoa] Waitemata Te Atarau Inpatient Unit Waitemata Tohu Wairua CMHT [Warkworth] Waitemata Waimarino Building Waitemata Waimarire Taharoto Road Waitamata Waitakere ECC Waitemata Waitakere Woodford House Wakari Hospital Wakatipu Community Mental Health Wanganui Paeds Wellington Clinical Services Block Wellington Paeds Wellington POSG Whakatane Hospital OTHER
Site Name 8	Select: ADHB CEC [Clinical Education Centre] ADHB Rangitoto Room [LabsPlus] Ashburton [Community Mental Health] AUT Midwifery Buller [Hospital] Canterbury Labs Carers New Zealand Central Otago Mental Health CLYDE [Dunstan Hospital] Christchurch CHOC Canterbury DHB Corporate Office Christchurch Echoscan 3000 Christchurch Parkside Training Room Christchurch Paeds Christchurch POSG Christchurch School of Medicine Clutha Community Health CMDHB Board Office CMDHB Kidz First Rm1 CMDHB Manukau Super Clinic CMDHB Staff Centre Cystic Fibrosis NZ Dunedin Hospital Funding & Planning Dunedin Mental Health EPS Dunedin Oncology Conference Room Dunedin Paeds Fiordland Community Health Centre [Te Anau Health Centre] Gisborne Hospital Gore Hospital Gore MHU Greenlane Quality Conference Room Greymouth Boardroom Greymouth Lecture Theatre Greymouth Mental Health Hawera Hospital HBDHB Education Centre [Hastings] HBDHB Lab Seminar Room [Hastings] Hillmorton [Hospital] Hillmorton Medlicott Room Hokitika [Health Centre] Hutt Valley Paeds Invercargill Community House Invercargill Governance [Southland Hospital] Invercargill Hospital Management [Southland Hospital] Invercargill Matai Room [Southland Hospital] Invercargill Paeds [Southland Hospital] Invercargill Primary Health Organisation KidzFirst [Middlemore Hospital] Life Unlimited Hamilton Life Unlimited Wellington Medsafe VC1 MidCentral Child Health MidCentral Clinical Library MoH 133 Molesworth VC1 MoH 133 Molesworth VC2 MoH 180 Molesworth VC1 MoH Dunedin VC1 MoH Hamilton VC1 MoH Hereford VC1 MoH KM House VC1 MoH Oxford VC1 MoH Penrose VC1 MoH Penrose VC2 MoH Terrace VC1 MoH Terrace VC2 MoH Terrace VC3 MoH Terrace VC4 MoH Wanganui VC1 Nelson Acute [Mental Health Unit] Nelson Bays Primary Health Nelson DHB [Office Meeting Room] Nelson Paeds Nelson Seminar Centre Northern DHB Support Agency Northern Southland College [Lumsden] NDHB Bay of Islands Hospital NDHB Dargaville Hospital NDHB Kaitaia Hospital NDHB Maternity NDHB Northland Breast Screening NDHB Northland DHB [Whangarei] NDHB Whangarei 2nd Floor Conf Rm NDHB Whangarei Mental Health NDHB Whangarei Paeds Oamaru [Waitaki Mental Health] Otago DCH [Child Health] Otago District Health Board [Dunedin Hospital] Parent to Parent Auckland Parent to Parent Central Lakes [Rotorua] Parent to Parent Christchurch Parent to Parent Coastal Bay of Plenty [Tauranga] Parent to Parent Dunedin Parent to Parent Manawatu [Palmerston North] Parent to Parent National [Hamilton] Parent to Parent Nelson Parent to Parent Southland [Invercargill] Parent to Parent Wellington Princess Margaret Hospital Reefton Rotorua Child Health Rotorua Mental Health Rotorua - Te Au O Hinetai Schizophrenia Fellowship New Zealand SISSAL Admin Starship Paeds Cardiology Starship POSG Starship Puawaitahi Starship VC Room [Level 3, Room 3.106] Taranaki Corp MR 1 Taranaki Corp MR 3 Taranaki Education Centre Rm1 Taranaki Education Centre Rm5 Taranaki Paeds [New Plymouth] Taupo Mental Health Tauranga Hospital TeleMidWifery Christchurch TelePaeds Network Admin Timaru Hospital Timaru MHU [Mental Heaalth Unit] Turangi Community Health Centre UoA School of Population Health Waikato Hospital Hockin Waikato Hospital Paeds Wairau Kimi Hauora Wairau Mental Health Wairau Support Services 1 Wairau Support Services 3 Waitemata Breast Screening Waitemata Helensville CMHT Waitemata NSH Lower Ground [North Shore Hospital] Waitemata NSH Tower [North Shore Hospital] Waitemata Red Beach CMHT [Whangaparoa] Waitemata Te Atarau Inpatient Unit Waitemata Tohu Wairua CMHT [Warkworth] Waitemata Waimarino Building Waitemata Waimarire Taharoto Road Waitamata Waitakere ECC Waitemata Waitakere Woodford House Wakari Hospital Wakatipu Community Mental Health Wanganui Paeds Wellington Clinical Services Block Wellington Paeds Wellington POSG Whakatane Hospital OTHER
Site Name 9	Select: ADHB CEC [Clinical Education Centre] ADHB Rangitoto Room [LabsPlus] Ashburton [Community Mental Health] AUT Midwifery Buller [Hospital] Canterbury Labs Carers New Zealand Central Otago Mental Health CLYDE [Dunstan Hospital] Christchurch CHOC Canterbury DHB Corporate Office Christchurch Echoscan 3000 Christchurch Parkside Training Room Christchurch Paeds Christchurch POSG Christchurch School of Medicine Clutha Community Health CMDHB Board Office CMDHB Kidz First Rm1 CMDHB Manukau Super Clinic CMDHB Staff Centre Cystic Fibrosis NZ Dunedin Hospital Funding & Planning Dunedin Mental Health EPS Dunedin Oncology Conference Room Dunedin Paeds Fiordland Community Health Centre [Te Anau Health Centre] Gisborne Hospital Gore Hospital Gore MHU Greenlane Quality Conference Room Greymouth Boardroom Greymouth Lecture Theatre Greymouth Mental Health Hawera Hospital HBDHB Education Centre [Hastings] HBDHB Lab Seminar Room [Hastings] Hillmorton [Hospital] Hillmorton Medlicott Room Hokitika [Health Centre] Hutt Valley Paeds Invercargill Community House Invercargill Governance [Southland Hospital] Invercargill Hospital Management [Southland Hospital] Invercargill Matai Room [Southland Hospital] Invercargill Paeds [Southland Hospital] Invercargill Primary Health Organisation KidzFirst [Middlemore Hospital] Life Unlimited Hamilton Life Unlimited Wellington Medsafe VC1 MidCentral Child Health MidCentral Clinical Library MoH 133 Molesworth VC1 MoH 133 Molesworth VC2 MoH 180 Molesworth VC1 MoH Dunedin VC1 MoH Hamilton VC1 MoH Hereford VC1 MoH KM House VC1 MoH Oxford VC1 MoH Penrose VC1 MoH Penrose VC2 MoH Terrace VC1 MoH Terrace VC2 MoH Terrace VC3 MoH Terrace VC4 MoH Wanganui VC1 Nelson Acute [Mental Health Unit] Nelson Bays Primary Health Nelson DHB [Office Meeting Room] Nelson Paeds Nelson Seminar Centre Northern DHB Support Agency Northern Southland College [Lumsden] NDHB Bay of Islands Hospital NDHB Dargaville Hospital NDHB Kaitaia Hospital NDHB Maternity NDHB Northland Breast Screening NDHB Northland DHB [Whangarei] NDHB Whangarei 2nd Floor Conf Rm NDHB Whangarei Mental Health NDHB Whangarei Paeds Oamaru [Waitaki Mental Health] Otago DCH [Child Health] Otago District Health Board [Dunedin Hospital] Parent to Parent Auckland Parent to Parent Central Lakes [Rotorua] Parent to Parent Christchurch Parent to Parent Coastal Bay of Plenty [Tauranga] Parent to Parent Dunedin Parent to Parent Manawatu [Palmerston North] Parent to Parent National [Hamilton] Parent to Parent Nelson Parent to Parent Southland [Invercargill] Parent to Parent Wellington Princess Margaret Hospital Reefton Rotorua Child Health Rotorua Mental Health Rotorua - Te Au O Hinetai Schizophrenia Fellowship New Zealand SISSAL Admin Starship Paeds Cardiology Starship POSG Starship Puawaitahi Starship VC Room [Level 3, Room 3.106] Taranaki Corp MR 1 Taranaki Corp MR 3 Taranaki Education Centre Rm1 Taranaki Education Centre Rm5 Taranaki Paeds [New Plymouth] Taupo Mental Health Tauranga Hospital TeleMidWifery Christchurch TelePaeds Network Admin Timaru Hospital Timaru MHU [Mental Heaalth Unit] Turangi Community Health Centre UoA School of Population Health Waikato Hospital Hockin Waikato Hospital Paeds Wairau Kimi Hauora Wairau Mental Health Wairau Support Services 1 Wairau Support Services 3 Waitemata Breast Screening Waitemata Helensville CMHT Waitemata NSH Lower Ground [North Shore Hospital] Waitemata NSH Tower [North Shore Hospital] Waitemata Red Beach CMHT [Whangaparoa] Waitemata Te Atarau Inpatient Unit Waitemata Tohu Wairua CMHT [Warkworth] Waitemata Waimarino Building Waitemata Waimarire Taharoto Road Waitamata Waitakere ECC Waitemata Waitakere Woodford House Wakari Hospital Wakatipu Community Mental Health Wanganui Paeds Wellington Clinical Services Block Wellington Paeds Wellington POSG Whakatane Hospital OTHER
Site Name 10	Select: ADHB CEC [Clinical Education Centre] ADHB Rangitoto Room [LabsPlus] Ashburton [Community Mental Health] AUT Midwifery Buller [Hospital] Canterbury Labs Carers New Zealand Central Otago Mental Health CLYDE [Dunstan Hospital] Christchurch CHOC Canterbury DHB Corporate Office Christchurch Echoscan 3000 Christchurch Parkside Training Room Christchurch Paeds Christchurch POSG Christchurch School of Medicine Clutha Community Health CMDHB Board Office CMDHB Kidz First Rm1 CMDHB Manukau Super Clinic CMDHB Staff Centre Cystic Fibrosis NZ Dunedin Hospital Funding & Planning Dunedin Mental Health EPS Dunedin Oncology Conference Room Dunedin Paeds Fiordland Community Health Centre [Te Anau Health Centre] Gisborne Hospital Gore Hospital Gore MHU Greenlane Quality Conference Room Greymouth Boardroom Greymouth Lecture Theatre Greymouth Mental Health Hawera Hospital HBDHB Education Centre [Hastings] HBDHB Lab Seminar Room [Hastings] Hillmorton [Hospital] Hillmorton Medlicott Room Hokitika [Health Centre] Hutt Valley Paeds Invercargill Community House Invercargill Governance [Southland Hospital] Invercargill Hospital Management [Southland Hospital] Invercargill Matai Room [Southland Hospital] Invercargill Paeds [Southland Hospital] Invercargill Primary Health Organisation KidzFirst [Middlemore Hospital] Life Unlimited Hamilton Life Unlimited Wellington Medsafe VC1 MidCentral Child Health MidCentral Clinical Library MoH 133 Molesworth VC1 MoH 133 Molesworth VC2 MoH 180 Molesworth VC1 MoH Dunedin VC1 MoH Hamilton VC1 MoH Hereford VC1 MoH KM House VC1 MoH Oxford VC1 MoH Penrose VC1 MoH Penrose VC2 MoH Terrace VC1 MoH Terrace VC2 MoH Terrace VC3 MoH Terrace VC4 MoH Wanganui VC1 Nelson Acute [Mental Health Unit] Nelson Bays Primary Health Nelson DHB [Office Meeting Room] Nelson Paeds Nelson Seminar Centre Northern DHB Support Agency Northern Southland College [Lumsden] NDHB Bay of Islands Hospital NDHB Dargaville Hospital NDHB Kaitaia Hospital NDHB Maternity NDHB Northland Breast Screening NDHB Northland DHB [Whangarei] NDHB Whangarei 2nd Floor Conf Rm NDHB Whangarei Mental Health NDHB Whangarei Paeds Oamaru [Waitaki Mental Health] Otago DCH [Child Health] Otago District Health Board [Dunedin Hospital] Parent to Parent Auckland Parent to Parent Central Lakes [Rotorua] Parent to Parent Christchurch Parent to Parent Coastal Bay of Plenty [Tauranga] Parent to Parent Dunedin Parent to Parent Manawatu [Palmerston North] Parent to Parent National [Hamilton] Parent to Parent Nelson Parent to Parent Southland [Invercargill] Parent to Parent Wellington Princess Margaret Hospital Reefton Rotorua Child Health Rotorua Mental Health Rotorua - Te Au O Hinetai Schizophrenia Fellowship New Zealand SISSAL Admin Starship Paeds Cardiology Starship POSG Starship Puawaitahi Starship VC Room [Level 3, Room 3.106] Taranaki Corp MR 1 Taranaki Corp MR 3 Taranaki Education Centre Rm1 Taranaki Education Centre Rm5 Taranaki Paeds [New Plymouth] Taupo Mental Health Tauranga Hospital TeleMidWifery Christchurch TelePaeds Network Admin Timaru Hospital Timaru MHU [Mental Heaalth Unit] Turangi Community Health Centre UoA School of Population Health Waikato Hospital Hockin Waikato Hospital Paeds Wairau Kimi Hauora Wairau Mental Health Wairau Support Services 1 Wairau Support Services 3 Waitemata Breast Screening Waitemata Helensville CMHT Waitemata NSH Lower Ground [North Shore Hospital] Waitemata NSH Tower [North Shore Hospital] Waitemata Red Beach CMHT [Whangaparoa] Waitemata Te Atarau Inpatient Unit Waitemata Tohu Wairua CMHT [Warkworth] Waitemata Waimarino Building Waitemata Waimarire Taharoto Road Waitamata Waitakere ECC Waitemata Waitakere Woodford House Wakari Hospital Wakatipu Community Mental Health Wanganui Paeds Wellington Clinical Services Block Wellington Paeds Wellington POSG Whakatane Hospital OTHER
ISDN/INTERNET
Site 1 Name
Site 1 Dial In/Out	Select: Dial In Dial Out Phone Only
Site 1 ISDN/Internet IP#
Site 1 Contact
Site 2 Name
Site 2 Dial In/Out	Select: Dial In Dial Out Phone Only
Site 2 ISDN/Internet IP#
Site 2 Contact
Site 3 Name
Site 3 ISDN/Internet IP#
Site 3 Dial In/Out	Select: Dial In Dial Out Phone Only
Site 3 Contact
I accept that there will be extra costs associated with using ISDN.
Tick to accept costs
MINISTRY OF HEALTH CHARGES ONLY (external calls)
Cost Centre
Project No.
Account Code
BILLING INFORMATION (if different from Organiser)
Full Name
Organisation
Address
Phone
Email