ANN 2018 Registration Form

Please fill out separate form for each person
Registration form may be printed and returned by post OR completed electronically and emailed.
Please return by 31 March 2018 to:
email: gedharris49@gmail.com
post: G Harris, PO Box 703, Castlemaine VIC 3450
Name: . …………………………………………………………………….           Male/Female
Address …..…………………………………………………………………….
…..…………………………………………………………………….
Telephone …..…………………………………………………………………….
Mobile (more useful than landline during Get-together) ………………………………….
Email …..…………………………………………………………………….
Field Naturalist Club …..………………………………………………………….
Special Dietary Requirements: (diabetic, vegetarian, coeliac, other) Please provide details.
…..………………………………………………………………….……………………………….
If staying at ANN venues indicate with whom you would prefer to share a room:
(To fit the expected number of participants in the available accommodation, 4 people will be accommodated in each room at Halls Gap. Please indicate if you prefer to share with another couple or people of same gender. Include names if possible.)
…..……………………………………………………………………………………………….….

Payment
Package Cost Deposit
Package 1 Full Package                        Cost: $1,310.00      Deposit: $400.00
Package 2 Own Transit Transport    Cost:$1,120.00       Deposit: $330.00
Package 3 Own Transit Transport and Own accommodation at Halls Gap and Anglesea.            Cost: $735.00    Deposit: $220.00
Package 4 Own Transit Transport and Own accommodation.                                                  Cost: $690.00   Deposit $210.00

Your Selection: Package ………….. Deposit $ …………..

Payment methods:
Cheque payable to SEANA Inc ANN Camp A/c
OR
EFT to bank account: SEANA Inc ANN Camp A/c, Commonwealth Bank BSB 063-506 Account No 10626086. PLEASE include your name as payee/reference.

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