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YCW REUNION 2010 website ticket registration

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YCW REUNION 2010 website ticket registration Powered By Docstoc
					                                                        YCW	
  REUNION	
  2010	
  -­‐	
  TICKET	
  REGISTRATION	
  
                                    	
  

Name:	
  
Mail	
  Address	
  for	
  tickets:	
  
	
  
Telephone:	
                                                                          Email:	
  
Number	
  of	
  tickets	
  required	
  @	
  $40	
  each	
                                                              	
  
I/we	
  will	
  be	
  attending	
  the	
  Lakers	
  game:	
                                                         Yes/no	
  
I/we	
  will	
  be	
  attending	
  the	
  Evening	
  function	
                                                     Yes/no	
  
Names	
  of	
  those	
  attending:	
  
	
  
	
  
Please	
  tell	
  us	
  in	
  a	
  few	
  words	
  your	
  connection	
  to	
  YCW	
  football	
  club.	
  	
  
(ie	
  era,	
  coach,	
  player,	
  committee,	
  parent	
  etc)	
  
	
  
	
  
	
  
	
  
Please	
  tell	
  us	
  what	
  awards	
  if	
  any	
  you	
  achieved	
  at	
  your	
  time	
  at	
  YCW.	
  
                                                                                 	
  
                                                                                 	
  
                                                                                 	
  
                                                                                 	
  
                                                                                 	
  
Please	
  tell	
  us	
  what	
  you	
  have	
  done,	
  as	
  far	
  as	
  football,	
  since	
  leaving	
  YCW	
  
	
  
	
  
	
  
	
  
PAYMENT	
  DETAILS:	
  

OPTION1:	
  	
                  Post	
  in	
  your	
  registration	
  form	
  and	
  cheque	
  m ade	
  out	
  to	
  “ YCW	
  Reunion”	
  

OPTION	
  2:	
  	
  	
          Make	
  a	
  direct	
  deposit	
  t o:	
  	
  BSB	
  	
  	
  	
  	
  033-­‐605	
  	
  	
  Account	
  N umber:	
  	
  	
  393522	
  	
  	
  BANK:	
  	
  Westpac	
  	
  	
  
                                And	
  post,	
  fax	
  or	
  email	
  this	
  form	
  along	
  w ith	
  your	
  receipt.	
  Please	
  quote	
  your	
  surname	
  as	
  reference.	
  
OPTION3:	
                      Complete	
  Credit	
  Card	
  Details	
  &	
  post,	
  fax	
  or	
  email	
  this	
  form	
                                   VISA	
          	
              MASTERCARD	
  

Credit	
  card	
  number:	
  	
  _	
  _	
  _	
  _	
  	
  	
  _	
  _	
  _	
  _	
  	
  	
  	
  _	
  _	
  _	
  _	
  	
  	
  	
  _	
  _	
  _	
  _	
  	
  	
  	
  	
  	
  Expiry	
  Date:	
  	
  	
  _	
  _	
  /	
  _	
  _	
  

Name	
  on	
  Card	
  _________________________	
  	
  Signature:___________________________	
  
                                And	
  post,	
  fax	
  or	
  email	
  this	
  form	
  
POST:	
   	
  	
  YCW	
  Reunion	
  C/-­‐	
  13	
  Rozel	
  Avenue,	
  Wendouree	
  3355	
  
FAX:	
  	
  03	
  53342491	
  
EMAIL:	
  lakerslockerroom@msn.com	
  
PHONE:	
  	
  John	
  Olszewski	
  0417	
  521331	
  

				
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Description: YCW REUNION 2010 website ticket registration