2015 West Coast Fever Awards Night
Booking Form
CONTACT DETAILS
First Name
Last Name
Address
Suburb
Post Code
Mobile Number
Email address
BOOKING DETAILS
Cost
West Coast Fever Members
$125.00 per person (inc GST)
Non-Members
$150.00 per person (inc GST)
Number of tickets
wish to purchase
Please complete guest names, membership card barcode no. (where applicable) and any dietary requirements
below. Max 10 guest per table..
Name of Guest 1
Name of Guest 2
Name of Guest 3
Name of Guest 4
Name of Guest 5
Name of Guest 6
Name of Guest 7
Name of Guest 8
Name of Guest 9
Name of Guest 10
PAYMENT DETAILS
Card Type (Mastercard or Visa ONLY)
Credit Card Number
Expiry Date (Month/Year)
CCV
Total $
Please sumbit your completed form to events@netballwa.com.au by Wednesday, 17 June, 2015.
For any queries please call (08) 9380 3700