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COUNTRY RUGBY LEAGUE REFEREES’ ASSOCIATION
WOLLONGONG SEMINAR 29th,30th & 31st January 2010
APPLICATION FORM
Mr K Riolo,
37 Brentwood Av
FIGTREE HEIGHTS NSW 2525
I will arrive at Surf Leisure Resort, Fairy Meadow on:
1. Friday night and will/ will not attend the BBQ [ ]
2. Saturday Morning for 8.00am breakfast [ ]
3. Saturday Morning after breakfast [ ]
I wish to order a Polo Shirt (Cost $20). My size is M, L, XL, XXL, XXXL.
(circle one size only)
Name: ________________________________________________________
Group: ______________________________
Please find enclosed:
Seminar Fee of $80* [ ]
Polo Shirt fee $20* [ ]
I am aware that it is compulsory to attend all sessions and lectures as set out in the Seminar program. I am also aware that should I fail to attend any sessions or lectures I may be liable for a fine, as set down by the CRLRA Executive, the minimum of which will be the full seminar fee of $152. This will be billed to me on the Sunday of the Seminar.
Signed:____________________________________________
Date:______________
*$80 fee includes 2 nights accommodation, 2 breakfasts, 2 lunches, and dinner on Saturday Evening. A BBQ at Towradgi Park Bowling Club will also be provided for those arriving before 7.00pm on the Friday. Persons not attending all lectures and sessions will be charged full accommodation cost of $152 and Polo Shirt cost of $30.
FORM TO BE RETURNED BY 20th December 2009
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