Form/Survey
Variety QLD Event Registration Form - YV Ball
GLITZ 'N' GLAM - 12 SEPTEMBER 2009 6pm
Rooftop Bar, Fox Hotel, Cnr Melbourne & Hope Sts Southbank
Contact Details
Title: *
First Name: *
Surname: *
Organisation Name:
Email: *
Contact Number: *
Address1: *
Address2: *
City: *
State: *
Postcode: *
Buy tickets
Tickets are $80 each - please choose the number of tickets you would like to purchase by indicating below:
Payment Amount: * (including GST)






Guest Details
Please enter the names of all guests attending the event.
Your Name: *
Guest One:
Guest Two:
Guest Three:
Guest Four:
Guest Five:
Guest Six:
Receipt Name
Please indicate how you would like your receipt/s to be issued:
Option:
Further information
It is our policy to provide supporters with information about our activities and from time to time ask for further support. We respect your privacy and will not pass your name on to any other organisation. Please view our Privacy Policy by clicking on the Privacy link at the bottom of the page.
Option: