ON-LINE TICKET APPLICATION FORM

To order your tickets on line please fill out this confidential form as fully as possible.

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INSTRUCTIONS

PLEASE NOTE:
Only use this form if you are paying by PayPal or by Bank transfer/Direct deposit:

• Click here to use PayPal.
  
• Seahorse Society Account
  Westpac
  BSB: 032-083
  Account number: 166511

* indicates required information.

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YOUR DETAILS

*Name:
Member Number (if applicable):
*Email address:

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NUMBER OF TICKETS

* Number of tickets:
* Total Price of Tickets: $
$50.00 each	$52.00 by PayPal

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PAYMENT METHOD

* Select one from the menu. Paid by PayPal Paid by Bank transfer/Direct deposit

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DELIVERY OF TICKET

* Select one from the menu. Post to me (fill in details below) I'll pick it up at a Social Meeting Hold for me to pick up on the night

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NAME AND POSTAL ADDRESS (if you select "Post to me" above)

Leave empty if you do not wish to receive your tickets by mail.

Title:	| Mr: | Mrs: | Miss: | Ms: |
Name:
Street address:
Suburb/Town/City:
State:	Select one NSW ACT NT QLD SA TAS VIC WA Not in Australia
Postcode:
State, Country (If not Australia):

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DIETARY PREFERENCES

Special dietary requirements (vegetarian meals):

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Please check that you have filled in all the required information marked *.