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Welcome to Reasons for Hope 2012 Online Registration. Payment can be made by direct bank transfer, credit card or cheque. To pay by cheque, please complete the registration form on the flier (postal details on flier). To make a payment online submit your personal details below and select a payment method. After submitting this form, you will be given the payment details (bank account information or link to the Paymate website for credit card payments) For registration problems / enquiries, please contact regos@reasonsforhope.net.au

First Name

Last Name

Age

Address 1

Address 2

Suburb

State       Postcode NSW ACT VIC QLD SA WA NT TAS

Telephone

Email Address

Occupation

University or School

Dietary Requirements

How did you hear about RFH? Previous RFH Word of mouth Facebook Email Theology on Tap ACSA The Harbour Cruise Parish My university chaplaincy CYSMy youth group Catholic Weekly Brochure our website Other   Do you need a lift from Gerringong train station? (we will contact you to confirm pick up time) No Yes Maybe

I give permission for RFH to pass on my details to the Australian Catholic Students Association and other catholic groups for event promotion purposes

Registration Option Full Weekend $130 Full Weekend (STUDENT) $115 Full Weekend INTERSTATE FLAT RATE $115 Full Weekend EARLY BIRD* $115 Full Weekend EARLY BIRD* (STUDENT) $90 Friday/Saturday (overnight stay) $90 Saturday/Sunday (overnight stay) $90 Saturday only $40 Sunday only $40 Please Note: * To receive the Early Bird Discount, payment must be received by 29th February, 2012 (No exceptions). * Due to accommodation, bookings are strictly limited to 100 places. Please register by 15 March for catering purposes. * Interstate flat rate applies to permanent residents in Vic, SA, WA, QLD & NT. * NO refunds or cancellations on any/all of the weekend. * If you need a lift from Gerrongong train station, please indicate this on this form. * First 20 registrants are eligible for a FREE surf lesson on 17 March with Culburra Beach Surf School

Payment Method Credit Card Bank Deposit / Bank Transfer (via internet banking) On the day

Reasons for Hope telephone enquiries: Richard - 0431 291 078 General enquiries: richard@reasonsforhope.net.au Site enquiries: richard@reasonsforhope.net.au