Bush Music Club Inc. - Ball Booking Form

Bush Music Club Inc.

Ball Booking Form

* required field
Name *
Address *
City: State: Postcode/zip:
Country:
Phone
Email
Special Requirements (e.g. gluten free, dairy free, vegetarian)
   
Tickets * 
BMC Members: at $35 each = $0
Non-Members: at $40 each = $0
Students: at $30 each = $0
Picnic: at $10 each = $0
Grand Total $0

Names of Dancers:

Enter details below of your electronic funds transfer to enable us to identify your payment
Direct deposit details: BSB 062-005 (Commonwealth Bank) Account 0090 7524
Please enter your name and the word 'ball' as the reference.

Amount deposited * $
Date deposited * / / (dd/mm/yyyy)
   
Verification * Verification image (Please enter the text in the image)