AQHA Magazine July August 2019 AQHA July-Aug 2019 Final | Page 64

PG.62 AQHA MEMBERSHIP RENEWAL 2019 AQHA Awards Night SATURDAY 12th OCTOBER 2019 6:00pm for 6:30pm VENUE: Pullman Melbourne Tickets - $75 Adults • $35 Children 12yrs & under TICKETS INCLUDES: Dinner Awards Presentation & Entertainment. Dress Smart Casual. I wish to purchase • Adult Tickets @ $75.00: (No.) _______________ • Children Tickets @ $35.00: (No.) _______________ List of people I am purchasing tickets for: _________________________________________________________ _________________________________________________________ DU G E U : ST _________________________________________________________ _________________________________________________________ 1ST AU 2019 _________________________________________________________ _________________________________________________________ _________________________________________________________ _________________________________________________________ _________________________________________________________ I wish to be seated with: __________________________________________________________ TO RENEW ONLINE: • www.aqha.com.au • Online Service • Membership Renewals • Online Membership Renewal 2019/2020 If you have trouble please phone the AQHA Office - 02 6762 6444 __________________________________________________________ __________________________________________________________ I am collecting Awards for (other than your own): __________________________________________________________ Name: ___________________________________________________ Membership Number: _______________________________________ Contact No: _______________________________________________ Email: ____________________________________________________ Any Special Dietary Requirements (please circle) YES NO Details if seafood allergy, gluten intolerant etc. CREDIT CARD DETAILS: Name on card: ______________________________________________ Credit Card Number: ________ / ________ / _________ / ________ Expiry Date: _______ / _______ Signature: ____________________________________________ Forms can be faxed to 02 6762 6422 or email to [email protected] AUSTRALIAN QUARTER HORSE ASSOCIATION