A Thai Cultural Evening in Canberra Registration Form

Registration Form

For

A Thai Cultural Evening in Canberra (1 April 2016)

Please fill in the form below
Full Name*

First NameLast Name
Date of Birth*

DayMonthYear
Gender*

MaleFemale
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number*

Area CodePhone Number
E-mail
Occupation
Note: Please bring your photo ID to pick up the ticket at the reception desk at least 30 minutes prior to the performance.
Should be Empty: