Dutch Club NAQ - Booking Form
Sinter Klaas
ABN 17 909 018 044
Title
Select one:
Mr
Mrs
Ms
Your Membership Status
Choose one:
Member
Non Member
Parents First Name
Parents Last Name
Address
City/Suburb
Post Code
Phone
Mobile
Email
No of Children
Choose one:
Member One Child - $20
Member Two Children - $40
Member Three Children - $60
Member Four Children - $80
Non-Member One Child - $25
Non-Member Two Children - $50
Non-Member Three Children - $75
Non-Member Four Children - $100
Please Note: It is important that you fill in the Name and Age of each child and if they are a boy or girl for type of gift they will recieve.
Ensure that each field is completed below for each child. If you have more than four children, please fill in a second form after you have finished this one by refreshing the page after you have submitted this form.
Choose your Payment Method
Choose a Payment Type:
Payment by Cash at the Club
Payment by EFT - Use your Name as Reference online.
Select Payment Date
DOB
Child 1
Boy
Girl
I Accept the Terms and Conditions of Booking
DOB
Child 2
Boy
Girl
DOB
Child 3
Boy
Girl
DOB
Child 4
Boy
Girl
Payment must be recieved by the cut off date to ensure your child receives their Gift.
Please remember to make your payment after submitting the form.
You will receive an email to confirm the your submission.
Payments can be handed to the Treasurer or to Dory at the shop in the club. (this is applicable for cash payments)
Payment can also be made by Electronic Funds Transfer (Bank Details will be sent to you by email)
By Checking the below you are electronically agreeing to the terms of membership with the Netherlands Association of Queensland. In this case you do not need to physically sign the form. However, if you print the form and fill it in you will need to sign the form when paying at the club.
Signature
T&Cs
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