U11 Development Program - ________________________________ (name of Participant)
Please Print off, scan & email to firstname.lastname@example.org
or post into the office - 16 Melbourne Street, Windsor, Qld 4030
BWHA accept the following payments (No payments accepted at the Program)
1. CASH - at the office.
2. CHEQUE - made payable to Brisbane Womens Hockey Assoc and mailed or handed in at the office.
3. DIRECT DEBIT - Brisbane Womens Hockey Assoc
4. CREDIT CARD - manually processed in the office (1% surcharge will be added to total). Please email details:
Name on Card: ___________________________________________
Card Number: ________ ________ ________ ________
Expiry Date: ____ / ____ CSV #: _________ (3 digit number on back of card) Cost to Participate: $35.00