Information Night - On-line Application
*
Denotes a Mandatory Field
1. Company Details
First Name
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Surname
*
Company Name
*
Company Address
*
Company Suburb
*
Company Postcode
*
Company Phone
*
Mobile
*
E-mail Address
*
How would you like to receive your reminders?
*
Email
SMS
2. Information Night
Preferred Location
*
-- Please Select
Albury/Wodonga
Ballarat
Bendigo
Bentleigh East
Bulleen
Croydon
Dandenong
Echuca/Moama
Geelong
Horsham
Mildura
Mornington
Sale
Shepparton
Swan Hill
Tullamarine
Warrnambool
Werribee
Registrations and drinks from 6pm, function commences 6.30pm sharp.
3. Attendees
I am a:
Member ($45.00 per attendee)
Non-Member ($60.00 per attendee)
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If you are also attending, please list yourself below
First Name
*
Surname
*
Any Dietary Requirements?
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Number of Attendees:
x $
=
$
4. Sign Off and Submit
I declare that to the best of my knowledge, that the information I have provided is true and correct.
*