Members Registration Form

Pleeeease fill in all the areas!

Name:		Position:
Name:		Position:
Company:
Address:		Suburb:
Postcode:		Phone:
Facsimile:		Email:
Special Dietary requirements:
	Vegetarian
	Other
Is this your first networking event:
	Yes
	No
Referral: I have been referred / invited by , an existing Leap Member.

PLEASE NOTE: TAX INVOICE WILL BE FAXED OR EMAILED AS SOON AS POSSIBLE AFTER THE EVENT

Payment & Cancellation policies

Cancellations must be notified in writing at least 3 days prior to the function, after that time FULL payment is required and no refunds will be given.
Cancellations and substitutions must be notified by phone to Secretary, LEAP Phone: 8361 1303

Mail: Secretary, LEAP-Inspiring Success
PO Box 3049, Caroline Springs 3023
Email: info@leap-inspiringsuccess.com.au