Balirt Biik Kiyiyt (Meeting) Request Form

Balirt Biik Kiyiyt (Meeting) Request Form

Request a meeting with the Baliṯ Biik (Strong Country) Team
Project Name / Location*
Organisation (making the request)*
Main Contact Full Name*

First NameLast Name
Main Contact Number*
Please enter a valid phone number.
Main Contact Email Address*
example@example.com

Billing Details

Cost: $1,500 ex GST
Review Meeting Additional Cost*

Under 500 Words - $550.00Word count between 501 words and 2,500 words $2,750.00 ex GST
Total Cost = $2,050.00 ex GST
Total Cost = $4,250.00 ex GST
Organisation Name*
ABN / ACN*
Billing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Contact Person*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Purchase Order Number (if applicable)

Agreement

I, as the Authorised Officer / Billing Recipient, warrant that the details provided on this booking form are true, correct, and accurate, and confirm that the submission of this booking form is acceptance of all terms and conditions associated with the booking including terms of trade and any applicable cancelation fees.
I agree with the above statement
Signature*
Date*

DayMonthYear
Date
Should be Empty:

Word count under 500 words	$550.00 ex GST
Word count between 501 words and 2,500 words	$2,750.00 ex GST

Booking Details