SA Scrapbook Convention l Online Booking Form

2010 CHARITY SCRAP CHALLENGE

Please complete the following information should you wish to pre-pay for your Charity Scrap Challenge Kit:
Select which event you will be attending:*
FIRST NAME:*
SURNAME:*
DELEGATE NUMBER:*
Example: STP023
CELL NUMBER:*
EMAIL ADDRESS:*
PAYMENT OPTION:*
Banking details will be forwarded should you choose to pay by EFT or Direct Deposit at the Bank.
CREDIT CARD TYPE:
CREDIT CARD NUMBER:
CARD EXPIRY DATE:
3 Digit Security Code:
AMOUNT TO BE DEBITED:
I would like to donate an additional amount to The Homestead:

YES NO
Straight or Budget:

Straight Budget
Budget Period:

3 months 6 months 12 months
Additional Amount:
Will you be attending the Charity Scrap Challenge ?*

YES NO
Additional Information:
Should be Empty:

info@scrapbookex.co.za • +27 82 456 1948 • www.scrapbookex.co.za