Real Australia Weekend

Registration Form 

Please return this completed application form with fee to:
BCA, PO Box 6565, Upper Mt Gravatt 4122

Name  
Address  
   
Tel (hm)  
(work)  
(mobile)  
Email  
 Full time $170  $  Part time Meals
 Part Time Accommodation (Please circle)

B

L

D

 
 $40 p.n.  Fr  $  Fr       $
 Sa  $  Sa       $
 Su  $  Su       $
 Linen $17  $  Mon       $
 Bed made $23  $

 Registration $15 day

$
 Sub total #1  $

Sub total #2

$
 

TOTAL #1 + #2

$

Payment details: Cheque  □   Credit   Exp _____________

Card #      _____________________________________________

Name       _____________________________________________

Signature _____________________________________________