Registration Details Form
Registration for:
@@@GLOBALS_eventName@@@ - @@@GLOBALS_venueState@@@
*
Company
*
Address 1
Address 2
*
Suburb
@@@IF_INCLUDE_showState_1_pay_if_no_show_state.htm@@@ @@@IF_INCLUDE_notShowState_1_pay_if_no_show_state_hidden.htm@@@
Member / Guest
*
First Name
*
Surname
Position
*
Email address
@@@GLOBALS_eventCorrespondence@@@
@@@WHILEARR_arrConsultants_INCLUDE_rsvp_row.htm@@@
Credit card details:
(your card will only be charged if you don't attend this function)
Total amount to be debited per person: @@@GLOBALS_eventValue@@@
*
Card type
Bankcard
Mastercard
Visa
Amex
*
Card No.
*Expiry date
Select
01
02
03
04
05
06
07
08
09
10
11
12
Select
2010
2011
2012
2013
2014
2015
2016
*
Name on card
@@@ERRARR_errRegistration_
_
_
@@@
Please note a cancellation fee of $25.00 per person applies to any late cancellations made with 96 hours of the event or if you NO SHOW at the event. Thank you.
©2010 TIFS Warehousing and Distribution