SMALL BUSINESS ASSOCIATION OF AUSTRALIA BOOKING FORM

ABN 26 143 126 498

SMALL BUSINESS ASSOCIATION OF AUSTRALIA BOOKING FORM ABN 26 143 126 498

Friday, 22 November, 2013

Friday, 22 November, 2013

A CELEBRATION OF SMALL BUSINESS GALA DINNER WITH MRS GINA RINEHART

A CELEBRATION OF SMALL BUSINESS GALA DINNER WITH MRS GINA RINEHART

PLEASE COMPLETE THIS FORM AND EITHER EMAIL TO: info@smallbusinessassociation.com.au OR FAX TO: 07 5578 3786
Name of person making booking: ________________________________________________ Tel (B): [
A/Hrs. [

] _______________________________________

] ___________________________________________________ Email: ______________________________________________________________

PAYMENT OPTIONS:
(1) Direct Deposit: BSB 064-475 Account: 1023 6604 Name: Small Business Association of Australia
(List your name as a reference)

MasterCard/Visa Card number _______________________________________________________________________________________________

Expiry:

3 Digit Security No:

_____________

(We processes through PayPal)

Name as shown on card: _________________________________________________ Signature: _______________________________________

Mailing Address as shown on your credit card statement: ____________________________________________________________________
Suburb: _________________________________________________________ Post Code: _____________________ State: ___________________

AMOUNT TO BE CHARGED: $ _____________

COST: $250 per person

Table $2,500 X 10 guests (GST inclusive)

Please provide all names attending on a separate list

NUMBER OF GUESTS:

______________

NUMBER OF TABLE/S:

______________

CORPORATE TABLE NAME:

________________________________________________