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BearsCanberra Inc. Christmas in July Friday 25 July Sunday 27 July 2008
Name: ________________________________________________________________ Address: _______________________________________________________________ City/Suburb__________________________ State ____________ Postcode___________ Phone_______________________________ Email: _____________________________ Please circle options (1 or any combination of 2, 3 and/or 4) 1 All inclusive (Fri Meet and Greet/Sat Dinner/Sun Recovery) YES $ 2 Meet and Greet (Friday night) YES $ 3 Dinner (Saturday night) YES $ 4 Recovery (Sunday morning) YES $
any special dietary requirements_________________________________ Payment Details: Please complete your credit card details below □ MasterCard □Visa Amount $ ..
Card No.□□□□ □□□□ □□□□ □□□□
Name on card .. .
Expiry date □□ □□ Signed
For more information,
Please send your completed form/s (one for each registrant) and payment to
The Treasurer BearsCanberra Inc, GPO Box 1694, CANBERRA ACT 2601
You may pay for more that one registration on this form but please fill in the applicants names on separate registration forms (keep grouped forms together) and let us know who your payment is intended to cover. |
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