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.

Number of people in ensemble

ACCOMMODATION:

Number of students

Number of Supervisors (single accomm)

Number of Supervisors
(shared accomm)

Bus Drivers (if not included as supervisor)

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

Generations In Jazz Inc.

PO Box 1098, Mount Gambier

SA, 5290

Applications close 9 March, 2012