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Your Name:
Phone:
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ABOUT YOUR EVENT
EVENT Name
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Location Line 1:
Location Line 2:
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State:
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QLD
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PostCode
Map Reference:
e.g. Melway 67-G4, Sydney UBD 220-F4
Area
e.g. Hunter Valley, Melbourne South
YOUR EVENT CONTACT DETAILS
Contact 1:
Contact 1 Phone:
Contact 2:
Contact 2 Phone:
Phone Enquiries:
Info Line:
Fax:
Skype
ID :
Windows Messenger ID :
Website:
Event Email:
Postal Address:
YOUR EVENT DATE(S)
Start Date:
End Date:
Hours From:
To:
Setup From:
Number of Stalls at the Event:
Stall Fee From $
Please describe your event:
PAYMENT OPTIONS (FEE $55.00)
By Funds Transfer:
To Market Stallholders Register BSB 062-572 Account No 10093608
By Credit Card:
Pay with Paymate Express
By Cheque:
The Market Stallholders Register. PO Box 407 Picton NSW 2571
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