Application and Order Form
* - required
Your Details:
Name:
*
Address:
*
Email:
*
Phone:
*
Firearm Licence No:
Please enter items required:
Ballot Application
$10.00
None
One Entry
Foundation Membership 07/08
$20.00
None
Yes, New Member
Yes, Renewal
Foundation T-Shirt
$35.00
None
Yes, Small
Yes, Medium
Yes, Large
Yes, XL
Yes, XXL
Yes, XXXL
Total Paid:
*
$
Closing date
for ballot
5:00pm Friday 21st September 2007
Other information:
Payment Details:
Before
submitting this form, please deposit your payment to:
Sambar Deer Management Foundation
03 0791 0235702-00 (Westpac Bank)
Payer's Name:
Payment Date:
Payment Reference:
*
Be sure to include a reference so that your payment can be linked to your application. Manual deposits are restricted to a numeric reference, such as a phone number. Deposits without a reference will be treated as a donation - Thank you.
ALTERNATIVELY
print and mail this form and your payment to:
Sambar Deer Management Foundation
P O Box 1250
Palmerston North
Your application must be received by
5:00pm Friday 21st September 2007
By submitting this form you acknowledge that your name, address and other details may be retained by Sambar Deer Management Foundation who may mail you information on Sambar Deer hunting and related matters.
