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 2022 - Mon 4th Tues 5th Wed 6thApril 2022 - Mon 18th Tues 19th Wed 20thApril 2022 - Mon 25th Tues 26th Wed 27thMay 2022 - Mon 9th Tues 10th Wed 11thMay 2022 - Mon 23rd Tues 24th Wed 25thJuly 2022 - Mon 4th Tues 5th Wed 6thAug 2022 - Mon 1st Tues 2nd Wed 3rdAug 2022 - Mon 22nd Tues 23rd Wed 24thAussie Gold Rush Camp / Mon 6th – Fri 10th June 2022Aussie Gold Rush Camp / Mon 20th – Fri 24th June 2022Mandurah Sat 12th Feb - Be a Better ProspectorMandurah Sat 19th Feb - Be a Better ProspectorMandurah Sun 13th Feb - Making a living out of GoldMandurah Sun 20th Feb - Making a living out of GoldWA 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?*NoYesEmailThis field is for validation purposes and should be left unchanged. This iframe contains the logic required to handle Ajax powered Gravity Forms.