Name:

Group:

Contact No.^*:

Email^*:

How many will be attending in total? (bookings for individuals or tables of 8 or 10)

Please write all names below- must be paid for together:

Bookings must be paid for in advance^#.

Will you pay through your group representative?
send us a cheque? (payable to SimTek Corporation Pty Ltd)
or pay by credit card? Please fax or send these details (this is not a secure server).
Alternatively, we will send you an invoice with direct deposit details.

Charge my Bankcard Mastercard VISA

Card number Expiry Date: Amount A$

Card Holder's Name:

CCV Number (last 3 digits on signature strip on card back):

^* You must supply a phone number or email for confirmation of booking.
^# Please contact us if you require to pay by cash.