Registration Form /
Kalgoorlie-Boulder 21 – 23 October 2016
LIONS CLUBS OF KALGOORLIE
Name / Lion Lioness Leo (Please circle)
Partner / If Partner is a Lion please register separately
Address Postcode
Phone / Mobile / Club
Email / First Conventioneer?
Y N
Time / Function / Number Attending / Cost (ea) / TOTAL
Prospector Train Ticket Perth – Kalgoorlie return (see next page) / $162.70/$88.00(conc)
Convention Pin / $5
Friday 21st October – Opening, Flag & Remembrance Ceremonies, Two-Up
Booths will be set up in the afternoon and Registrations will be open from 4.30pm to 5.45pm
Call to Order 6.00pm
8.00pm / Beer & Burgers / $15
8.00pm / Two-Up Game / $10
Saturday 22nd October – Business Session & Guest Speakers
Continuous tea and coffee, morning and afternoon tea will be provided free of charge
12.30 – 1.30pm / Lunch / $35
7.30pm / All That Glitters Dinner Dance
Dress: Glittery or Smart Casual / $55
Sunday 23rd October – Fun and Relaxation
9.30am / Kalgoorlie Amazing Race / Free
9.30am / Tour Options (to be advised) / Prices Vary
12.30pm / Lunch / $20
Less Early Bird Deposit
GRAND TOTAL
Special Dietary Requirements
Other Requirements
Transport Requirements (Railway Station to Accommodation to Venue)
Please send your completed form to Goldfields Convention 2016, P.O. Box 477, Kalgoorlie WA 6433 or by email to
Payment either by cheque (payable to Kalgoorlie Lions Club Inc) OR Electronic Banking: Westpac Bank BSB: 036-125 Account: 58-1034 use your name as reference. Please note electronic receipt number on your registration form.
CHAIRPERSON - Susan Leeson 0420 835 962 / SECRETARY– Eddie Rochester 0418 954 270
TransWA Prospector Train
.A copy of the Prospector timetable can be found at https://www.transwa.wa.gov.au/Bookings/Timetables
Journey Out (Perth to Kalgoorlie)
Friday 21 October – Departs East Perth 7.10am / Journey Back (Kalgoorlie to Perth)
Sunday 23 October – Departs Kalgoorlie 2.05pm
PASSENGER LIST / CONCESSION INFORMATION
NO. / GIVEN NAME / SURNAME / TITLE / FARE TYPE **** / DATE OF BIRTH / CONCESSION
NUMBER / EXPIRY DATE
1
2
3
4
**** CONCESSION TYPES
CHD - Child aged 5-15 years (children under 10 years must be accompanied by an adult)
Date of birth is required for all children travelling.
TSP - Student aged 16 years or older with a Transperth Students SmartRider card.
Please indicate SR Number, located at the top right hand corner on the rear of the card along with Student’s date of birth which is needed to validate card.
PCF - Western Australian Pensioner Free Trip Voucher - Number and expiry date required.
PCR - Western Australian Pension Card - Number and expiry date required.
SNR - Western Australian Senior - SmartRider number and date of birth required.
ISN - Interstate Senior - Senior card number required.
HCC - Western Australian Health Care Card - CRN and expiry date required.
YHC - Youth Hostel Association - Card number required (YHA or VIP cards).
ADU - Adult (no concession card)