Dinner Registration Form

TWO EVENTS - SAME DAY - SAME PLACE

Seminar: The Advantages for your Co-operative of Global Connections
3:45pm - Coffee 4:00pm - Start
Free - but you must register

Dinner: 6:00pm - Pre Dinner Drinks 6:30pm - Dinner and speakers
$65 per person (GST inclusive) - Two course dinner with beer, wine and soft drinks

REGISTRATION FORM

Section A: Contact Person
Title:
First Name:		Last Name
Organisation:
Position Held:
Telephone No:
Facsimile No:
Email:
Mobile No:
Section B: Attendees at Dinner
Title:	First Name: Last Name:
Title:	First Name: Last Name:
Title:	First Name: Last Name:
Title:	First Name: Last Name:
Title:	First Name: Last Name:
Title:	First Name: Last Name:
Section C: Attendees at Seminar
Title:	First Name: Last Name:
Title:	First Name: Last Name:
Title:	First Name: Last Name:
Title:	First Name: Last Name:
Title:	First Name: Last Name:
Title:	First Name: Last Name:

Section D: Payment (for Dinner only)
Total amount payable:	@ $65 per person
Payment method:	I will post a cheque payable to The Mercury Centre Co-operative Limited GPO Box 4825 Sydney NSW 2001
	Email me with account details for a direct transfer of funds.
	Payment will be via Visa/Master Card/Diners (appears as eGive Services). I confirm that I am authorised by the card holder to make this payment. Card No: Name on Card Expiry date:
Please email a Tax Invoice to the Contact person

TWO EVENTS - SAME DAY - SAME PLACE

REGISTRATION FORM

Section A: Contact Person

Section B: Attendees at Dinner

Section C: Attendees at Seminar

Section D: Payment (for Dinner only)