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

2010 Hadassah Australia Dinner

Non-Credit Card Bookings

Please complete and submit the form below.

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 IS THE TOTAL TO BE PAID
Method:
 
Details of other guests
  Guest name Member ? Guest Contact (email or phone)
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  Comments (seating requests, vegetarian, etc):
     

 

IMPORTANT: Please ensure that your payment is made promptly by one of the following methods:

EFT / Internet Transfer / Bank Deposit:

Account Name: Hadassah Australia Inc
BSB: 033047
Account Number: 430084

Cheque:

Payable to: Hadassah Australia Inc
Post to: PO Box 2400,
Caulfield VIC 3161 Australia
Include: Your contact & booking details