School Name

Name of Contact

Purchase Order No.

Title

Postal Address

City/Town/Suburb

State

Post Code

Telephone
(incl. area code)

Facsimile

Mobile

Email Address

Please ensure details provided above are appropriate to contact person.

Please nominate the division you wish to participation in:

ACCOMMODATION:

Number of students

Number of Supervisors (single accomm)

Bus Drivers (if not included as supervisor)

Please post a deposit cheque of $500 (registration & accommodation)
per band to:

Generations In Jazz Inc,

City of Mount Gambier National Stage Band Awards
PO Box 1098, Mount Gambier

SA, 5290

Applications close 11 March, 2011