Booking form Your Contact Information First name:*Last name:*Date of birth:Address:City/Suburb:State:WA Western AustraliaNSW New South WalesNT Northern TerritoryQld QueenslandSA South AustraliaTas TasmaniaVic VictoriaOtherPostcodeHome Phone:Mobile:*E-mail:*How did you hear about us?*WebPublicationReferralOtherCourse or Aussie Gold Rush Camp informationPreferred course/camp date:*April 2024 - Mon 22nd Tues 23rd Wed 24thMay 2024 - Mon 13th Tues 14th Wed 15thMay 2024 - Mon 27th Tues 28th Wed 29thJune 2024 - Mon 3rd Tues 4th Wed 5thAug 2024 - Mon 5th Tues 6th Wed 7thAug 2024 - Mon 19th Tues 20th Wed 21stAussie Gold Rush Camp / Mon 24th June – Fri 28th June 2024Aussie Gold Rush Camp / Mon 8th July – Fri 12th July 2024Mandurah Sat 16th March, 2024 - Be a Better ProspectorMandurah Sun 17th March, 2024 - Next Level ProspectingWA Miner's Right number:APLA Membership number:Type of Vehicle:Vehicle Registration:Do you own a metal detector? If so, what type?How experienced are you in using a metal detector?Preferred method of payment:* Cheque Direct Transfer Would you like to prospect on one of our tenements after the course?*YesNoSafety informationNext of kin contact name:*Home Phone:Mobile:*Relationship:*Do you have any medical conditions of which we should be aware of?*NoYesDo you take any medication of which we should be aware?*NoYesPhoneThis field is for validation purposes and should be left unchanged. This iframe contains the logic required to handle Ajax powered Gravity Forms.
