EmailMeForm
Burnie H3 - Burnie Ten Weekend registration
Burnie 10 "Hashers in Wonderland" - October 18-19 2014
Name
*
First
Last
Hash name
*
HHH Chapter
Email
*
Mobile Phone #
Activities Selection
Please select the activities you would like to attend. Check all that apply.
Select activities
*
Saturday Run * $20
Hashers in Wonderland evening $30
Après Burnie10 $10
THE LOT! $60
Payment
*
Cheque payable to: Burnie Hash House Harriers ............ (C/- PO Box 1152, Burnie 7320)
Direct deposit^: BSB 012295 Account 599038004
^ use hash name as reference
Image Verification
Please enter the text from the image:
[
Refresh Image
] [
What's This?
]
Powered by
EMF
Form Builder
Report Abuse