SCA National Dinner Booking Form

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Personal Details First Name: Last Name: Street: City: State: ACT NSW NT QLD SA TAS VIC WA Postcode: Phone:  (please include area code) Email:   Event Select your Dinner from this list NATIONAL - Celebration & Awards Champions Dinner VIC (TUE 7 OCT 2008) STATE - QLD SCA Fundraising Champions Dinner (TUE 25 NOV 2008)   Seating Individual- $75.00 Number of seats Select 1 2 3 4 5 6 7 8 9 10 Table (10) - $700.00 Number of tables Select 1 2 3 4 5   Payment How are you paying? Select One Cheque Mastercard Visa Cheques can be made out to 'Sports Chaplaincy Australia Inc.' and sent to PO Box 219 Burwood 3125. Thanks.   Credit Card Details Name on Card: Expiry Date: 01   02 03 04 05 06 07 08 09 10 11 12 2008 2009 2010 2011 2012 2013 2014 2015 Card Number: Amount Paid: $   Notes Notes: