Samford Valley Business Network

“Samford On Show” Booth  Registration Form

Company/Business Name____________________________________________________________

ABN   ____________________________________________Preferred Booth Number   __________

Address    _________________________________________________________________________

__________________________________________________________________________________

Product/Service Description  _________________________________________________________

Public Liability $5000000 Cover Policy No_______________________________________________

Policy Company Name_______________________________________Expire Date______________

SITE AREA  IS 3m x 3m AT A COST OF $100 EACH

TENT COVER TO BE PROVIDED BY STALL HOLDER

SET UP BY  9.30AM

Contact Name  _____________________________________________________________________

Title _________________________ Phone _________________   Mobile ______________________

Emergency Contact Number  _________________________________________________________

Email _____________________________________________________________________________

Web Address ______________________________________________________________________

Signature _______________________________________________  Date   __________________

RETURN THIS REGISTRATION FORM WITH $100 REGISTRATION FEE TO:

SVBN EXPO, c/- Scott Noble, SAMFORD GROVE,

PO BOX 118, SAMFORD 4520 (MOB 0438 832 689) OR

TRANSFER FUNDS TO:  SVBN;BSB:014307  ACC: 490928214

CHEQUES MADE PAYABLE TO SAMFORD VALLEY BUSINESS NETWORK

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SVBN Confirmation Details:

Date paid ____________________________Amount ______________

Site No. _____________________________

Receipt/Invoice Issued ________________Date       ______________