New Norcia 

Library Lecture 2010

Please complete and return this form by Wednesday, 1 September 2010

.Registration Information

 Title: First name: Surname:

 Title: First name: Surname:

 Library: Email:

.Tickets

Number of tickets

New Norcia Library Lecture 2010

. ADULTS: $77*

 __________

. STUDENTS: $33*

 __________

*Includes morning tea, lunch & free entry into Museum & Art Gallery





Receipts provided. Tax invoice on request. Details required for tax invoice:

 Institution: Address: Fax number:

.Payment

TOTAL: $____________

Cheque: . Please make payable to the Benedictine Community of New Norcia

Credit Card: . Visa . MasterCard 

Name on card:______________________________________________ Signature:______________________________________________________

Card No: ____ ____ ____ ____ / ____ ____ ____ ____ / ____ ____ ____ ____ / ____ ____ ____ ____ Expiry Date: ____ ____ / ____ ____

TAX INVOICE: ABN 44 823 848 404

Please complete & return to: Sue Johnson, New Norcia Library,

Benedictine Community, New Norcia WA 6509

Phone: (08) 9654 8060 (Wed-Fri) Fax: (08) 9654 8097 

Email: library@newnorcia.wa.edu.au