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Hengel Bonanza - EFT & Registration Form

Dear Sir/Madam,
EFT PAYMENT FOR ANGLING TICKETS – TEAM SUPER CAST ROODEKOPJES BONANZA
You are hereby invited to buy your angling tickets online via EFT payment if you do not have a credit or cheque card. Please fill in the form below (all information is compulsory) send the completed form with payment reference to angling@stywelyne.net or 086 622 7945. As soon as form and payment is received, your tickets will be emailed to you. This form will serve as your registration and ticket to the Team Super Cast Roodekopjes Bonanza.

* Use the tab key and not enter to go to the next field
Title:
Surname:
Company (if appl.):
Address:
City & Code:

First Name:
State/Province:
Country:
Business Tel:
Mobile/Cell:
Business Fax:
E-mail:
Date of Birth:	yyyy / mm / dd

I am paying for:

Angling Tickets:

Adults – R250.00, How many?
Children – R120 (o/15), How many?

Total Amount (please fill in): R

Camping Fees:

R100 per adult camping for the weekend, How man?
R50 per child camping for the weekend, How many?
R40 per day visitor, How many?
R20 per boat, How many?

Method of payment:

Electronic transfer into our bank account

Account: Bonanza l ABSA l Account No: 405 4720 242 l Branch Code: 323145

Your Random Verification Number (RVN): 68738

Please retype the RVN seen above in red. Use this number as reference when making a payment:

* By submitting this form, you accept our rules & regulations (click to read)
* Also complete our registration form, before your entry will be submitted/accepted

Amelia van der Merwe
Business Manager

(c)