MS Gong Ride : Entertainment and Performers

EXPRESSION OF INTEREST

BUSINESS NAME *

ABN *

ADDRESS LINE 1 *

ADDRESS LINE 2

SUBURB *

STATE *

POSTCODE *

WEBSITE URL

SOCIAL MEDIA LINK

IS YOUR ORGANISATION A NOT FOR PROFIT? *

WOULD YOU LIKE TO DONATE YOUR SERVICE FREE OF CHARGE? *

FIRST NAME *

LAST NAME *

PHONE

MOBILE

EMAIL ADDRESS *

LIST OF EQUIPMENT YOU WILL BRING *

LIST OF EQUIPMENT YOU WOULD LIKE PROVIDED *

AREAS IN WHICH YOU ARE INTERESTED IN PERFORMING (SELECT ALL THAT APPLY) *

TEMPE
ENGADINE
WATERFALL
ROYAL NATIONAL PARK
FAIRY MEADOW (WOLLONGONG)

BRIEF DESCRIPTION OF SERVICES/PERFORMACE *

ADDITIONAL NOTES

CERTIFICATE OF CURRENCY (PLEASE ATTACH)