Please print and complete this form and fax it to The Brisbane Institute on 3229 8902 or email to

Your Name (required)

Your Email (required)

Your Address (required)

Your Telephone (required)

Credit Card Payments:

Please charge my Visa/Mastercard in the amount of

being payment for

tickets at $25

concession tickets at $15

tickets at $10 for fulltime UQ students

Card Number

Expiry date )

Cardholder name )

Signature )

* $15 concessions available to Brisbane Institute annual subscribers and full time students. Special discount for full time UQ students $10. Quote student number when booking

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