Annual Retreat Booking Form

THIS ONLINE FORM ACCEPTS CREDIT CARD PAYMENTS ONLY.
You will be directed to the ANZ egate secure payment facility after you have submitted your form.

If your payment is successfully processed, your transaction receipt number will appear below. You will also receive a confirmation e-mail including your receipt number and a copy of your application.

QuiltNSW does not collect nor store any credit card information in conjunction with this payment facility.
Please direct any technical queries to: forms@quiltnsw.com

2017 Annual Retreat Booking Form

Hotel Academy Kurri Kurri NSW: 14/15-17 September 2017
Full payment due by 31 August 2017

Name*
First Last
Address*
Street Address City State Post code
Telephone:*
Email*
Current QuiltNSW individual financial member?*
- Yes
Booking*
- Two nights - Single ensuite room $555
- Two nights - Twin ensuite room $420 per person
- Two nights - Single shared amenity room $415
- Two nights - Twin shared amenity room $348 per person
- Three nights - Single ensuite room $675
- Three nights - Twin ensuite room $500 per person
- Three nights - Single shared amenity room $485
- Three nights - Twin shared amenity room $398 per person
Sharing room with
full name
Please list any special dietary requirements
Deposit*
Price: $ 50.00
Total
$ 0.00
Comment