Individual Recharge Rego Form recharge

Any Enquiries: Emily Dickinson email or 0434 046 961

Applications close Monday 15th August 2011

 

DETAILS    
 
ADDRESS:  
EMAIL:  
CONTACT No:  
CHURCH:  
AGE:  
     
ACTIVITIES/ACCOMMODATION    
FRIDAY:    
.
  Will you play Laser Tag on Friday at 8pm in Forrestdale - Battlezone Laser?
(If so, please download a form off the Battlezone Laser website to play)



 

Will you stay Fri night at Serpentine Camp?
     
SATURDAY:    



 

Will you stay Sat night at Serpentine Camp?
     
MEALS    
(PLEASE TICK ALL THAT APPLY)    
Sat Breakfast  
Sat Lunch  
Sat Dinner  
Sun Breakfast  
Sun Lunch  
     
Any special requirements (dietary/accommodation?)  
     
Any further questions or comments  
 

PAYMENT METHODS

1) By cheque: please make cheques payable to 'Churches of Christ in WA'

2) By EFT: please transfer the amount owing to the following account and provide a remittance advice to Emily Dickinson.

Account Name: Youth Vision WA
BSB: 036 000
A/C: 228 050

Please include your church name & RECHARGE in the transaction detail so that we can clearly identify your payment.

 
     
Click here to submit your online rego