email:   australia@hadassah.org
tel:   1800 HADASSAH  (+61 3 9500 2681)

2010 Hadassah Australia Dinner - Credit Card Bookings

Please complete and submit the form below.
When you click "Submit" you will be automatically redirected to Westpac PayWay
for secure processing of your credit card payment.

Fields shown with * must be completed.

Your Details:

First Name*: Surname*:
       
Email*: Salutation:
       
Preferred Phone*: Alternative Phone:
       
Address Line 1: Address Line 2:
       
City / Suburb: State: or other:
       
Post / Zip code: Country:
       
Number of Places*
Member: @ AU$100.00 Non-member: @ AU$115.00
       
Total $: < THIS AMOUNT WILL BE CHARGED TO YOUR CREDIT CARD
 
Details of other guests
  Guest name Member ? Guest Contact (email or phone)
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  Comments (seating requests, vegetarian, etc):