REGISTER ON LINE shoalhavenmensconvention.org.au or ring Mick on 44 437 326 by TUESDAY, 27th AUGUST $25 Register Online Please complete the form below to register online. Fields marked with an * are required. NAME* First Last ADDRESS* Street Address City State / Province / Region ZIP / Postal Code PHONEMOBILEEMAIL* HOME CHURCH Brunch will be provided on the day. DIETRY REQUIREMENTS*Please select one from the list below;I don't have any specific requirementsVegetarianVeganGluten FreeLactose IntolerantOtherOther Dietary Requirements*Please Specify.Payment Type*Direct DepositRegistration Fee - Shoalhaven Men's Convention*Brunch is included in the price. Price: $ 25.00 Direct Deposit Details Account Name: Shoalhaven Men's Convention BSB: 633 000 Account Number: 156022154 Reference: Please use your full name as the reference.
