2014 ACT CHIEF MINISTER’S INCLUSION AWARDS
Principal sponsors: MAXEmployment and Drake Medox
EVENT DETAILS:
THURSDAY 11th DECEMBER 2014
Time: 6.00pm for 6.30pm
Venue: Great Hall, Parliament House
Format: Dinner & Awards Presentation
Attire: Semi-formal
BOOKING & PAYMENT FORM:
Please note: BOOKINGS CLOSE 5.00pm FRIDAY 28th NOVEMBER
Name of Organisation:
Name of person responsible for this booking:
Telephone: Mobile:
Email:
Price: $110.00 Full Price
$55.00 Support Workers
$30.00 Concessions
$0.00 Carers
In order to qualify as a Carer, a Companion Card Number is required. In order to qualify for a Concession, an Income Support Payment Number or Pensioner Concession Card Number must be provided. For all Support Worker tickets, place of work is required.
I wish to book:
[] seats @ $110.00 each = $
[] seats @ $55.00 each = $ / Place of Work []
[] seats @ $30.00 each = $ / Income Support or Concession Card Number []
[] seats @ $0.00 each / Companion Card Number []
Total amount payable: $
Companion Card information & application form: www.companioncard.act.gov.au
Or please contact: Doris Campbell 6205 5122 | | TTY: 6205 0888
NAMES OF GUESTS NAME OF ORGANISATION
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Please choose the form of payment, complete all details and fax, post or e-mail this form with your payment.
Option 1 - PAYMENT VIA CREDIT CARD:
Visa Mastercard Bankcard (please select one)
Cardholder’s Name:
Total Amount to be charged to your credit card: $
Card Number:
Expiry Date: CCV:
Signature:
Option 2 - PAYMENT VIA CHEQUE:
Your cheque should be made payable to:
BDW Special Events Management
Please return this booking form by:
Credit Card Bookings by Fax: 02 6248 8122
Credit Card Bookings by Email:
Credit Card or Cheque Bookings by Post: BDW Special Events Management
GPO BOX 2495
CANBERRA ACT 2601
Important!
Confirmation of your booking
On receipt of your booking you will be issued a confirmation notice
If you do not receive a confirmation notice, please contact BDW on 02 6195 0831
Please bring your confirmation notice to the event
Special Requirements
It is important for the organisers to know of any special needs you or your guests may have.
This will assist in making your evening an enjoyable one. Please identify any special dietary or other requirements such as special seating requirements, visual or hearing impairments or any other needs of which we should be aware.
Accessibility Information
The event will be fully equipped with a hearing loop, live captioning and interpreter services.
Proudly Sponsored by:
MAXEmployment Drake Medox
ActewAGL House with No Steps
Just Better Care The Canberra Times
Canberra Institute of Technology IBM
ACTION
BDW SPECIAL EVENTS PTY LTD ABN 22 055 774 493 GPO BOX 2495 CANBERRA ACT 2601
T 02 6195 0831 F 02 6248 8122