Register for the Dancing With The Local Stars

Name

Company

Address

City

State

Postcode

Phone

Email


I would like to book tickets for Dancing With The Local Stars

tickets at $175 per person inclusive

tables at $1750 per table of ten

or

I am unable to attend, however I'd like to make a
donation to the Hear and Say Centre for
$.00


I would like to pay upon


If paying by credit card, please supply the name of the person to contact

Name:

Contact No:

Thank you for your booking and for your support of the children of
the Hear and Say Centre.

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