Children Camp / Parivar Camp – 5th to 8th October – 2017 REGISTRATION FORM

Surname (required)

First Name (required)

School Year (required)

Address

No. & Street (required)

Town / City (required)

Country (required)

Post Code (required)

Date of Birth (required)

Telephone (required)

Mobile (required)

Your Email (required)

Gender (required)

MaleFemale

Please state any essential medical/dietary requirements or ALLERGIES

Med. Card No

Parents Name (required)

Emergency Contact Number (required)

Parents Email ID (required)

"PAYMENT - Please make EFT (electronic fund transfer) using below bank links and paste EFT receipt number in below field"

https://www.commbank.com.au/

http://www.anz.com.au/personal/

http://www.nab.com.au/

http://www.westpac.com.au/

http://www.stgeorge.com.au/

http://www.bankofmelbourne.com.au/

EFT Reference Field (required)