South East Metro Region (Home of the South East Seagulls)

Coaching Seminar Registration Form

Region 15

Coaching Seminar Registration Form

Name:______________________________________________________________________________
Email Address:______________________________________________________________________
Mailing Address:________________________________________________________________________

Postcode:_____________________     CCA Member:  Yes/No

Please tick either:                             Senior Coach:             Junior Coach:

 

NON CCA MEMBERS TO APPLY, PLEASE COMPLETE THE FOLLOWING PAYMENT OPTION:
 
Please ensure you attach your $10 payment and forward back to Paul Montgomery before Friday November 14, 2008. 
Payment can be made by cheque or money order (please ensure it is made out to Cricket Victoria).
We also accept the following credit cards: 

Bankcard:          Mastercard:             Visa:           Diners:           American Express:

Card No:
Expiry Date:                 …………/20…….
Card Holder’s Name:  …………………………………………………………………………..
Signature:                    ………………….………………………………………..……………..
Upon receipt of payment, this document will be a Tax Invoice for GST purposes, please keep a copy for your records

 

If you have any queries please call Paul Montgomery on 0413 888 395 or email  pmontgomery@cricketvictoria.com.au

 

Please Note:    Registrations close 5.00pm

Friday 14 November, 2008

 

 

 

 
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