Kurrajong Village Collectables & Antique Market

Submtting this form electronically is not always reliable if it does fail please print off this form and send with your remittance to the address given below

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Your Email:

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NAME *

BUSINESS/TRADING NAME

ABN

ADDRESS *

HOME PHONE

MOBILE NO.

BUSINESS NO.

FAX NO.

EMAIL ADDRESS

BUSINESS WEBSITE (if you have one)

PLEASE LIST A BRIEF DESCRIPTION OF THE ITEMS YOU WISH TO SELL. *

How Many Tables will you require? (1 Table $45, 2 Tables $80) measuring 180CMS X 76CMS each. *

MY REMITTANCE CHEQUE WILL BE FORWARDED WITH THIS ENTRY ALONG WITH A VALID CERTIFICATE OF iNSURANCE FOR PUBLIC LIABILITY (minimum $10 million)

CHEQUES MADE PAYABLE TO BERNICE MELROSE

MAILING ADDRESS - 61 KURRAJONG ROAD, KURRAJONG NSW 2758.

DIRECT DEBIT PAYMENT FOR TABLE/S CAN ALSO BE MADE PLEASE CONTACT AN EVENT ORGANISER (SEE HOME PAGE)

PLEASE INDICATE IF POWER IS REQUIRED (power is not available to all tables and is allocated on first come first served basis.)

I agree that the Kurrajong Village Collectables & Antique Market organizers shall not be held liable for any accident, loss or damage, which may occur to any display or property.

Signed .........................................................

Dated ..........................................................

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