Please complete all details so we can check our records and produce new name tags for newcomers/lost tags.
All personal details will be treated confidentially and used only for distribution of Coral Reunion information and for other oral Reunion Member's enquiries. (It will only take you 1 minute to complete this Form But it will certainly help us a great deal...THANKS,"
Surname of Attendee: Given Name:
Preferred name or nickname: Army Service No:
Sub Unit (e.g. 3 PL A Coy): Unit:
Address:
State: P/C:
Mobile Phone: E-mail:
ADDITIONAL GUESTS 1st and last name of accompanying person
SPECIAL DIETARY NEEDS:
COST DETAILS (Including a raffle ticket) $85.00 Single $165.00 Couple
Extra Raffle Tickets $5.00 each
Insert Number Totals
Single x $
Double x $
Extra Raffle Tkts x $
Donation $
The Payment Amount I'm sending/transferring TOTALS: $
YES NO I will pay direct through Bank Electronic Transfer to the Reunion Account
ST George Bank BSB 112-908 A/c 02103134. You must include your 'Name' and including 'Coral'.
YES NO I will pay with a Cheque/Money Order made out only to "Coral Reunion"
PLEASE SEND FORM TO THE ADDRESS BELOW OR EMAIL TO THE EMAIL ADDRESS BELOW:
Ray Curtis
7/9 Coral Drive, Jerrabomberra Heights, NSW 2619
Jerrabomberra Heights NSW 2619
If you have NOT received a receipt within 4 weeks after sending , then Phone or Email Ray to fix it.
Phone Number: 0457825290 Email: rosandray4@bigpond.com
