<p> Miller Harris Lawyers Send Hope Not Flowers Fundraising Lunch</p><p>Direct deposit registration form</p><p>Thank you for your interest in our event. In order to ensure that we have your details correctly recorded, and to match your payment to our account, please complete the following steps. </p><p>1. Direct deposit payment</p><p>Our account details are as follows:</p><p>Miller Harris Lawyers Send Hope Account</p><p>BSB: 064 804 </p><p>Account: 1391 7736 </p><p>Option Ticket type Price for direct deposit payment A Single ticket (early bird on or before 29.09.17) $77.50 B Table of 10 (early bird on or before 29.09.17) $697.50 C Single ticket (from 30.09.17) $85.00 D Table of 10 (from 30.09.17) $765.00</p><p>Please advise us of which option you are taking, how many tickets you would like to book, the total amount of the transfer and the date of your transfer.</p><p>Date of direct deposit Amount deposited Option being purchased (A to D, as listed above) Number being purchased</p><p>Level 1, 14-16 McLeod Street | PO Box 7655, Cairns QLD 4870 Telephone: 07 4036 9700 | www.millerharris.com.au | [email protected] 2. Complete the registration form</p><p>Please provide us with the following details, in order that we can send you out your receipt. </p><p>Prefix (Mr., Mrs., etc.): First Name: Last Name: Email Address: Mobile: Job Title: Company/Organisation: Country: Address: Address: City: State/Territory: Postal Code:</p><p>Are you coming as part of a group, or with friends? If so please let us know who you would like on your table, so that we can try our best to make sure you are seated together. </p><p>______</p><p>______</p><p>Do you have any special dietary requirements? ______</p><p>______</p><p>3. Are you booking more than one ticket?</p><p>If so, please provide us with the following details, for each additional guest.</p><p>Prefix (Mr., Mrs., etc.): First Name: Last Name: Email Address: Job Title: Company/Organisation:</p><p>4. Contact us</p><p>Once your payment has been made, and your registration form is completed, please either fax (07 4031 1525) or email ([email protected]) your completed registration form to us. We will then forward your receipt within 710 days. </p><p>Thank you! Your support of this event, and Send Hope Not Flowers, is greatly appreciated! Thank you to our major sponsors </p>