Online Booking Form

Booking form

Your Contact Information

First name:*
Last name:*
Date of birth:
Address:
City/Suburb:
State:
Postcode
Home Phone:
Mobile:*
E-mail:*
How did you hear about us?*
Course or Aussie Gold Rush Camp information
Preferred course/camp date:*
WA 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?*
Safety information
Next of kin contact name:*
Home Phone:
Mobile:*
Relationship:*
Do you have any medical conditions of which we should be aware of?*
Do you take any medication of which we should be aware?*
Comments
This field is for validation purposes and should be left unchanged.