Booking Request

Use this form to request enrolment in:

• Defensive Driver Training Course - STAGE 2
  COST: $300

After FULL PAYMENT is received, your request will be processed and confirmation with further details will be forwarded to you. As course numbers are limited and conditions apply, acceptance of your request is not automatic. You must receive our confirmation before the booking is firm.

Available Dates: see the Course Dates field below.

		NB: ALL fields must be completed
Course Dates		Choose Sun 28th March 2010 Fri 16th April 2010 Tues 6th July 2010 Thur 12th August 2010 Thur 23rd September 2010 Mon 18th October 2010 Mon 22nd November 2010 Thur 16th December 2010    Licence Choose Full
Your Name
Address
Suburb		Postcode
Phone
Mobile
Email
Gift to		(optional name to appear on Gift Certificate if required)
Guest Lunch		(Lunch is supplied for you but $15 each extra for each guest you bring)
Vehicle		(make and model of your vehicle that you will be using)
Payment by		Credit Card  OR  Direct Deposit  OR  Prepaid Gift Certificate
Gift Certificate		(Enter the number on your prepaid gift certificate if you have one)
Payment by		Credit Card  OR  Direct Deposit
Pay by Card		If paying by Mastercard OR VISA Card complete below. If Direct Deposit preferred, follow details further below.
Card Holder
Card Number		Expiry
		NOTE: All Credit Card Transactions will incur a 3.0% Surcharge, all prices displayed are in Australian Dollars (AUD) and include GST

Pay by Direct Deposit
Be sure to include a reference in the form stipulated here so that we can identify your payment.

Reference		(your surname)-DT2
Bank		Commonwealth
Account		Australian Racing Drivers Club
BSB		062-004
Account#		10086042

Copyright ^© 1999-2009 Australian Racing Drivers Club Limited. Ph: +61 2 9672-1000