25th Anniversary Registration Name Address Phone Email Number of years you where a member of the Southern Rugby Club Do you have any dietry requirements? Yes No If yes please list your dietry requirements Included in the Registration fee is – Gift bag and jubilee book on arrival, Friday night Supper, Luncheon, evening food plus entertainment on Saturday also a guest speaker for Sunday. Registration $70 per person* – includes Chilly Bag or Wine Tote (please select) plus other memorabilia. --Chilly BagWine Tote-- Commemorative Polo Shirt $35 – Male or Female (please select) --MaleFemale-- Size (please select) --SMLXL2XL3XL4XL5XL-- Sunday Luncheon $35 per person (please select) --YesNo-- Total to pay: Payment methods: Internet banking: Please deposit funds into – Southern Rugby Football Club 25th Jubilee Account - 15-3950-0752592-000 (Please use your full name as a reference) Cheque: Please return this registration form with your cheque payable to the Southern Rugby Club. These can be posted to: Southern Rugby 25th Anniversary PO Box 382 Hawera 4640. Send If you require accommodation click here for options.
