CA
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SE
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‘A91
VID
- PLUS SPECIAL GUEST MICHAEL CHEIKA
B RISBANE C ONVENTION
1 1 : 3 0 AM
AND
E XHIBITION C ENTRE
T H U R S D AY 1 6 J U LY 2 0 1 5
FOR 1 2 : 0 0 PM CONCLUDES 4 : 0 0 PM
Fox Sports’ Nick McArdle will interview a stellar lineup of guest speakers including former New
Zealand All Blacks coach Sir Graham Henry, Wallabies back and 1991 Rugby World Cup player of
the tournament David Campese, 1991 Rugby World Cup winning coach Bob Dwyer, Wallabies
wing Ben Tune and the Springboks' youngest ever captain Bob Skinstad.
Plus special guest and Wallabies head coach Michael Cheika.
Join us for an afternoon celebration of the Rugby World Cup to toast our greatest World Cup
victories and a look ahead at our 2015 stars making their own history this year.
Date:
Thursday 16 July 2015
Time:
11:30 for 12pm start til 4pm
Ve n u e :
Brisbane Convention & Exhibition Centre
Lunch Cost:
$250 per person inc GST
($225 per person for members inc GST)
REGISTRATION FORM / TAX INVOICE
STEP 1
YOUR DETAILS
Name:
Company*:
Address:
Postcode:
Phone:
Mobile:
Email:
Date:
No. of seats @ $250 each (inc. GST):
dd/mm/yy
No. of Member seats @ $225 each (inc. GST):
OPTION: SPLIT TABLE FOR NETWORKING OPPORTUNITIES YES
NO
*Please note: Invoices will be raised under Company Name when provided. Please use full legal entity.
STEP 2
PAYMENT OPTIONS
Acceptable methods of payment are by electronic transfer or credit card only. Full payment is required on placement of application.
An administration fee of 3% will be added for all payments made by credit card.
ELECTRONIC TRANSFER
Electronic Transfer Queensland Rugby Union for the amount of:
Account Name: Queensland Rugby Union Ltd
BSB #: 334-005
$ 0
Account #: 553 511 011
Payment Reference:
CORPLL15.............................................................................................................................
Please email remittance to [email protected]
CREDIT CARD Card Type:
Visa
Mastercard
AMEX
Card Number: CCV:
Amount: $
0
+ Admin Fee (3%): $
0.00
= Total Amount: $
Name on card:
0.00
Expiry:
(date: mm/yy)
Card Holders Signature:
I authorise Queensland Rugby to adjust the grand total if any errors are found in my calculations.
Office Use Only:
Date paid:
Receipt #:
Initial:
Invoice #:
Tax invoice: this document serves as a Tax invoice for GST purposes when making payment. Please photocopy and retain for your
references and tax records. Queensland Rugby Union Ltd ABN 95 055 120 217, 231 Butterfield Street, Herston, Qld, 4006.
PLEASE TURN OVER FOR GUEST INFORMATION
STEP 3
ATTENDEE NAMES
Guest 1
Guest 2
Name:
Name:
Member ID:
Member ID:
Company:
Company:
Email:
Email:
Dietary Requirements:
Dietary Requirements:
Guest 3
Guest 4
Name:
Name:
Member ID:
Member ID:
Company:
Company:
Email:
Email:
Dietary Requirements:
Dietary Requirements:
Guest 5
Guest 6
Name:
Name:
Member ID:
Member ID:
Company:
Company:
Email:
Email:
Dietary Requirements:
Dietary Requirements:
Guest 7
Guest 8
Name:
Name:
Member ID:
Member ID:
Company:
Company:
Email:
Email:
Dietary Requirements:
Dietary Requirements:
Guest 9
Guest 10
Name:
Name:
Member ID:
Member ID:
Company:
Company:
Email:
Email:
Dietary Requirements:
Dietary Requirements:
RETURN COMPLETED FORM TO:
Corporate Sales at Queensland Rugby, PO BOX 205 Kelvin Grove DC QLD 4059
Email: [email protected]
Fax: (07) 3856 6333 Ph: (07) 3354 9311
Queensland Rugby Union Ltd ABN 95 055 120 217