QRU STAFF AND PARTNER MEMBERSHIP FORM YOUR DETAILS Title: First Name: MyRugbyID: Surname: D.O.B: / / Street: Home: Suburb: Mobile: State: Postcode: Email: ADDITIONAL MEMBERS Full Name: Email: D.O.B: / / Full Name: Email: D.O.B: / / Full Name: Email: D.O.B: / / Full Name: Email: D.O.B: / / Full Name: Email: D.O.B: / / CHOOSE YOUR PACKAGE Membership Type: Membership $ Quantity - Adult: Concession: Junior: Family 4: Family 2: Total: BRISBANE GLOBAL RUGBY TENS TICKETS • All ten Australian and New Zealand clubs TWO DAY PACKAGE* plus Toulon, the Blue Bulls, Samoa and the Panasonic Wild Knights Qty Adult Qty Conc. Qty Junior • Ten-players-per-side, ten-minutes-per-half, Platinum $217.95 NA NA knockout tournament • Over AU$1.6 million in annual prize money Gold $181.35 $163.15 $117.25 • 18 man squads with unlimited interchanges Silver $126.40 $108.10 $80.60 • Sanctioned by the Australian Rugby Union and Bronze $90.70 $72.35 $54.05 the New Zealand Rugby Union White $69.00 $69.00 $49.00 Total: $ *Includes 10% discount for being a 2017 St.George Queensland Reds member. Ticketek transaction fees apply. Only valid until 30th November 2016. REDS FOUNDATION I would like to make a donation to the Reds Foundation. $20 $50 $100 Other $ PAYMENT DETAILS Credit Card Visa Mastercard AMEX Email
[email protected] Payment Plan Annual Rolling Payment Mail Return this completed form to: St.George Queensland Reds Membership 12 Month Payment Plan PO Box 3458 *All orders on the payment plan will be processed through DebitSuccess. Newmarket A $5 set up fee & 3% administration fee applies.