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 2021 - Mon 5th Tues 6th Wed 7thApril 2021 - Mon 19th Tues 20th Wed 21stApril 2021 - Mon 26th Tues 27th Wed 28thMay 2021 - Mon 10th Tues 11th Wed 12thMay 2021 - Mon 24th Tues 25th Wed 26thJuly 2021 - Mon 5th Tues 6th Wed 7thAug 2021 - Mon 2nd Tues 3rd Wed 4thAug 2021 - Mon 16th Tues 17th Wed 18thSept 2021 - Mon 6th Tues 7th Wed 8thAussie Gold Rush Camp / Mon 7th – Fri 11th June 2021Aussie Gold Rush Camp / Mon 21st – Fri 25th June 2021WA 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.