Register now for the 2008 Ampersand Walk
Team registration for the 2008 Ampersand Walk
Before submitting this form, have you:
Completed all sections for each walker in your team?
Nominated an organisation to support?
Paid your registration fee of $20 per person before september 1st (early bird special)
otherwise $25 per person ($100 per team).
Ensured each walker has signed the Participant's Declaration?
Click here
to download a copy of the Participant's Declaration form and return to:
The Ampersand Walk Team
537 Brunswick Street
Fitzroy North Vic 3068
An administration fee applies.
$25 per person ($100 per team)
Please fill in the information below and click Submit.
TEAM DETAILS
Team Name:
Walker 1:
Walker 2:
Walker 3:
Walker 4:
Estimated walk time:
(Hours)
(Minutes)
Heard about The Walk:
The team commits to raising $400 (minimum) for:
Jesuit Social Services
www.jss.org.au
The Oaktree Foundation
www.theoaktree.org
Edmund Rice Camps Vic.
www.ercvic.com
St Vincent de Paul Society
www.vinnies.org.au/vic
The team has paid its non-refundable $100 ($25 per-person) registration fee:
In person or via electronic transfer
Ampersand Walk (National Australia Bank - BSB 083 457 A/C 87449 3627)
IMPORTANT: Team name must be entered in the 'Transaction Description' field
By Cheque or Money Order
Made out to 'Ampersand Walk' and posted to 537 Brunswick Street, Fitzroy North 3068
Team name must be recorded on the reverse side of the cheque or slip
WALKER DETAILS - WALKER 1
First name:
Family name:
Date of birth:
Sex:
Female
Male
Occupation status:
Studying
Working
Volunteering
Other
Telephone:
(Daytime)
(Mobile)
Email address:
Postal address:
Postcode:
Emergency contact:
(Name)
(Phone)
WALKER DETAILS - WALKER 2
First name:
Family name:
Date of birth:
Sex:
Female
Male
Occupation status:
Studying
Working
Volunteering
Other
Telephone:
(Daytime)
(Mobile)
Email address:
Postal address:
Postcode:
Emergency contact:
(Name)
(Phone)
WALKER DETAILS - WALKER 3
First name:
Family name:
Date of birth:
Sex:
Female
Male
Occupation status:
Studying
Working
Volunteering
Other
Telephone:
(Daytime)
(Mobile)
Email address:
Postal address:
Postcode:
Emergency contact:
(Name)
(Phone)
WALKER DETAILS - WALKER 4
First name:
Family name:
Date of birth:
Sex:
Female
Male
Occupation status:
Studying
Working
Volunteering
Other
Telephone:
(Daytime)
(Mobile)
Email address:
Postal address:
Postcode:
Emergency contact:
(Name)
(Phone)
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