Scleroderma Qld AGM & Seminar Registration

Scleroderma Qld AGM & Seminar Registration

Saturday 26 October 2024

RBWH Education Centre & Video Conference

Bowen Bridge Rd &, Butterfield St, Herston QLD 4006

Registration starts 10 am
Lunch included

Name

First NameLast Name

Email

example@example.com

Address

Street Address

Street Address Line 2

CityState

Postcode

Phone Number

Area CodePhone Number

I'll be there (Select all that applies)*

Total Amount Owed

Payment Methods*

MAIL Please attach cheque or money order, payable to Scleroderma Assn. Of Qld Inc. 54 Avocado Lane, Maleny, QLD, 4552BANK TRANSFER Scleroderma Assoc of QLD - BSB:638-070 ACC: 7271069 REF: Your Name

Are you bringing a guest/s?*

YESNO

If yes, please provide their names

Please let us know for catering purposes of any dietary requirements.

VegetarianVeganCoeliacAllergies

THANK YOU

Once payment is received your registration will be confirmed.