Replacement Badge Order Form

Replacement Badge Order Form

This form can be used to order replacement badges.
Club*
Club ID*
Postal Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Contact Name*
Contact E-Mail*
Contact Phone*
Assessor Information
Assessor Name*
Tech ID #*
E-mail*
Contact Ph:*
Athlete Information
Please enter Athlete Information
Payment Information
Prices:

Cost Per Badge

$7.50
Number of Badges Ordered*
Total Cost ($)**
**Note: All amounts are inclusive of GST.
Methods of Payment:

***Please Note: Badges will not be sent until payment is received***

EFT:

Gymnastics Victoria Inc.

BSB: 063 103 Account: 008 003 11

Ref: Club Name or ID#

Cheque:

Made payable to Gymnastics Victoria

Mail to:

Gymnastics Victoria

PO Box 350

Prahran, VIC 3181

Credit Card Payments:

Via Paypal (MasterCard and VISA only) - you will be redirected after hitting submit; you can use a PayPal account or select 'pay by card' to enter card details.
Method of Payment*

EFTChequeCard

Terms & Conditions
1. Payment must be made in full for badges to be received.

2. Forms must show full details of each gymnast to obtain badges.

3. Gymnasts must be registered with Gymnastics Victoria and Gymnastics Australia in order to obtain a badge.

4. Please select the appropriate discipline and level for the required badges.

5. Please use a separate line for each discipline.

6. Prices are subject to change.
Please ensure all Athlete, Club & Assessor information is correct before clicking submit.

If you have any queries, please contact Claire Firth:

PH: 03 9005 4700 E: info@gymnasticsvictoria.org.au
Should be Empty:

Assessor Information