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ANZA CHALLENGE 2013 T-SHIRT ORDER FORM Full Name Phone Email Harcourts Office Postal Address Shirt Size S - XL PAYMENT t-shirts are 50 each incl.GST 100 of which will be donated to the Halberg Disability Sport Foundation I have posted a cheque payable to Halberg Disability Sport Foundation Please post to Harcourts Regional Office PO Box 99-549 Newmarket 1023 I authorise Halberg Disability Sport Foundation to debit my credit card Visa Mastercard Card Number Expiry Date Cardholder s Name...
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