Father’s Day 2017 Bluesalt Breakfast Buffet with Beer Booking Form Sunday, 3 September, 2017 Bluesalt Breakfast Buffet with Beer 9:00 – 10:45am Name: ……………………………………………………………………… Address: …………………………………………………………………… Suburb: ………………… Postcode: …………. Telephone: ……………………......................... Mobile: ……………………………………... Email: ……………………………………………………………………………………………… No. of adults: ...… $40.00 No. of children (7-17 years) ...… $29.00 No. of children (6 years & under) …… Complimentary High chair required …. .. Tick Additional comments/dietary requirements: …………………………………………………………………… Total amount to be charged: …………………….. Type of credit card (Please circle): Visa Amex Mastercard Bankcard Diners Credit card number: (Please note only provide the last 4 digits on this form – we will call to confirm the full card number) …………….. Expiry date: …………………. Signature: …………………………………….. Date: …………………….. Amount: ……………………. I would like to be kept informed of other events and offers at Crowne Plaza Coogee Beach, Sydney. I understand that full pre-payment is required upon booking and as such I hereby authorise Crowne Plaza Coogee Beach to debit my credit card for the above amount. If you prefer to come in and pay with cash, payment is required with 48 hours in order to secure your booking. I also understand that there will be NO refunds after 1st September 2017. I understand a 1.5% merchant service fee is applicable to Visa and Mastercard transactions and 3% merchant service fee is applicable to Amex and Diners transactions. Your confirmation letter and ticket number will be sent to you at the above address once your credit card payment has been processed. Please print clearly and return to the Events Co-ordinator at Crowne Plaza Coogee Beach Email: coogee.events@ihg.com Ph: 02 9315 9182