Member 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

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*First Name
*Surname
Position
*Email address
Vegetrian
  @@@PLAIN_sWholesaler@@@
  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  
  *Card No.    *Expiry date   
*Name on card This amount will only be charged if you no show or cancel within 48 hrs
 


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_

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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.

 
 
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