Ellipsis Awards Presentation 2017
Please complete the following form to purchase your tickets to the Ellipsis Awards Presentation 2017.

Date: Friday 28 April
Time: 7:00 pm for a 7:30 pm start
Dress: Cocktail
Venue: Firechief 169 Camberwell Road, Hawthorn East

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Name? *
Please provide a contact email or mobile number *
Ticket Details
This section is about the types of ticket you would like to purchase. If you would like to purchase more than four member / non-member tickets, please complete this form again.
How many member tickets would you like to purchase ($45 each)? *
You are a member if you were part of the 2016 Mixed Nationals or Manila Spirits Teams, the 2017 Women's Team, or the 2016/2017 VUL team.  
How many non-member tickets would you like to purchase ($55 each)? *
Dietary requirements
Please outline any dietary requirements:
Payment Details
Please transfer the total amount by Wednesday 19 April 2017 to:

Name: Ellipsis Ultimate Inc
BSB: 063 113
Account: 1111 7319

Description: <<Your Surname>> Awards

Member Price: $45
Non-Member Price: $55
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