Registration – 2012 National Gathering QLD


I have made the payment and the payment reference number is*:

(If you haven't made the payment yet - pay by bank transfer to:
Adult: $350 (Register by 31st January 2012 & pay $320!)
Big Grom (13-16yrs): $260
Grom (6-12yrs): $200
Mini Grom (2-5yrs): $100
All prices include 4 days of dorm accommodation and food.

Account Name: Christian Surfers Australia
BSB: 036 123
Acct: 296 600
Description/Reference: “NGath-SURNAME” (eg: “NGath-SLATER”)

Surname*:

First name(s)*:

Attending groms & ages:

Home address*:

City*:

State*:

Postal code*:

Mobile*:

Email*:

CS Mission you belong to*:

Dietary requirements:

T-shirt cut*:

T-shirt size*:

Second t-shirt cut and size for couple registrations:

MEDICAL DETAILS

Medicare number*:

Name on Medicare card*:

Emergency contact phone number*:

Any serious medical conditions we should know about:

ARRIVAL*: Driving Flying into Brisbane Flying into Sunshine Coast Airport

ARRIVING FLIGHT DETAILS (If you want a pick-up before National Gathering)

Number of people:

Flight number:

Date:

Time:

DEPARTURE*:  Driving Flying from Brisbane Flying from Sunshine Coast Airport

DEPARTING FLIGHT DETAILS (If you want a drop-off after National Gathering)

Number of people:

Flight number:

Date:

Time:

Any other additional information or we should know about:

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