Request edit access
ADR Medallion On Line Order Form 2017
Australia Day Regatta Medallions are generally awarded to 1st, 2nd and 3rd handicap placegetters (including crews of junior 2-up classes) in divisions of five or more entries.

In divisions of one class with ten to fourteen entries, a medallion may also be awarded for 1st on scratch. In divisions of one class with fifteen or more entries, 2nd and 3rd scratch placegetters should receive a medallion.

Prizes for 2nd and 3rd placegetters may be presented immediately after the event or at the annual prize giving of the individual conducting clubs. First placegetters, including junior class 2-up crews, will be invited to the Sydney Town Hall in March 2017 to receive their medallions, which will be engraved with the winner's name.

Payment may be made by Bank Transfer to Australia Day Regatta Commonwealth Bank BSB 062-099 Acc # 1041 7961 (Please ensure you provide the name of your club) or Cheque made payable to Australia Day Regatta PO Box 162 Neutral Bay NSW 2089.

Medallions will be dispatched upon confirmation of payment.

Please complete the following information with payment by Friday February 3, 2017

Club
Your answer
Contact Address
Your answer
Contact Phone
Your answer
Email Address
Your answer
Number of medallions required @ $15 each
Names of First place medallion recipients will be required later. First place medallions will be presented at a function at the Sydney Town Hall.
First Place
Your answer
Second and Third Place
Your answer
Total Cost (1st,2nd and 3rd)
Your answer
Delivery Address
Your answer
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Additional Terms