Platinum Achiever

Please complete the form below.

* = required

Member Details

Title:	A value is required.*
First Name (as it appears on photo ID):	A value is required.*
Surname (as it appears on photo ID):	A value is required.*
Company:	A value is required.*
Email:	A value is required.*
Business/Home Phone:	A value is required.*
Mobile:	A value is required.*
Postal Address:	A value is required.*
Suburb:	A value is required.*
State:	Please select an item.*

Flight Information

Please advise us of your preferred flight details into Hobart. We suggest that you check the flight schedules for Virgin and Jetstar as these have the most frequent flights into Hobart.

Carrier:
Airline Membership Number:
Flight Number:
Departure City:	A value is required.*
Departure Date:	A value is required.*
Departure Time:	A value is required.*
Special Requests:

Please advise us of your preferred flight details out of Hobart.

Carrier:
Airline Membership Number:
Flight Number:
Which city are you flying to?	A value is required.*
Departure Date:	A value is required.*
Departure Time:	A value is required.*
Special Requests:

Accompanying Person - 1

Title:
First Name (as it appears on photo ID):
Surname (as it appears on photo ID):
Mobile:

Partners are invited to join members for lunch on Thursday and Friday at the Hotel Grand Chancellor. Please advise if your partner will be attending:

	Thursday
	Friday

Please indicate here if your partner will be joining the afternoon activity on Thursday.

Yes No

Please advise us here of your partners preferred flight details into Hobart.

Same as above, or
Carrier:
Airline Membership Number:
Flight Number:
Departure City:
Departure Date:
Departure Time:
Special Requests:

Please advise us of your partners preferred flight details out of Hobart.

Same as above, or
Carrier:
Airline Membership Number:
Flight Number:
Departure City:
Departure Date:
Departure Time:
Special Requests: