Registration Form

Full Name *

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

Attendance Confirmation - Select the day(s) you will attend.

Friday 28th

Saturday 29th

Sunday 30th

Do you wish to book a camping site? *

Yes

No

Select the day(s) you require the site:

Friday 28th

Saturday 29th

Sunday 30th

If you are able to assist with any of the following, please select those that apply.

Security/Concierge

Cleaning (including toilets)

Food preparation, BBQ's etc

Displaying art and facilitating interactive artwork.

Running or assisting with workshops

Social Media

Payment Information

It is preferable if payments are made by EFT to the following Regional Australia Bank Account Account Name: Goori-Bugg Family Reunion BSB: 932 000 Account Number: 100542774 Please indicate your name for the deposit information. - Registration Fee - $20 per adult - Camping Fee - $10 per night If you are using phone banking your device may not recognise the Regional Australia Bank – the solution is to scroll down and click on “Confirm” which will enable you to proceed with the transaction. We appreciate that Internet Banking is not available to everyone and that there are a limited number of Regional Australia Bank branches. Given these constraints, will you prefer to make a cash payment at the Reunion?

Yes

No

Given varying circumstances of all, this registration fee will be waivered in cases of hardship with no proof required. Would you prefer to have this fee waivered?

Yes

No

Are you interested in attending a dinner in Gloucester on Sat 29 th March 6pm – 8pm? Menu and cost will be sent out at a later date but we have booked a private function room with seating for 120.

Yes

No

Are you interested in attending an excursion to Buggs Creek etc.?

Yes

No