Program: Boys 375

Start Date: Sunday, 19th of Sep 2010

Places left: 2 places. Filling up.

Details

Use this form to register your place on a program. Once we have received your payment we consider your spot reserved and will hold it for you.

Once you submit this form we will send you a confirmation email and an invoice for your records. The email will have a link to download the 10 Day Program information pack that has the forms, equipment lists and other details that you will need prior to coming on the program.

Refunds

We do not offer refunds less than 6 weeks prior to the program, however you are welcome to switch to a later program so please consider carefully prior to making a booking.

Questions
If you have any questions regarding the bookings form or procedure you can email Tom - tom@mittagundi.org.au. Tom will usually get back to you with in 1 business day.

Booking Form

Parent/ Guardians Name *

Parent/ Guardians Email Address *

We use this address to send the confirmation, medical forms and other reminders.

Home Phone Number *

Parent/ Guardian mobile number / name/ relationship. (eg. 0412 345 789, Peter, Dad.)

Parent/ Guardian mobile number / name/ relationship. (eg. 0412 345 788, Robyn, Mum.)

Street Address *

Suburb, Town or City *

State *

Postcode *

Participants Name

Participants Email Address

Participant Date of Birth *

School Attended

Payment Method *
Credit Card (preferred)
Request Sponsorship
Cheque/ Money Order
Cheques: send to Mittagundi, 4385 Omeo Hwy, Glen Valley, Vic, 3898

Name on Card

Card Number

Card Expiry

Card Type

CCV Number

Amount paid today*

Optional: Subscribe to the Mittagundi Newsletter

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