Please print and complete this form and fax it to The Brisbane Institute on 3229 8902 or email to rsvp@www.brisinst.org.au

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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