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AAC Dinner Plain
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Membership Enquiry Form
First Name
*
Surname
*
State or Territory
*
-- Select --
ACT
NSW
NT
QLD
SA
TAS
WA
VIC
Other
Your interest in using the lodge... when
*
in summer (Dec-Jan)
in snow season
in long weekends/holidays
Your interest in using the lodge... who
*
myself mainly
myself & family
myself & friends
What information would you like?
1000
characters left
How did you find out about AAC Dinner Plain?
*
web search (Google, Bing etc)
advertisement on a website
ad in a magazine or newspaper
article in a magazine or newspaper
brochure
ad at Dinner Plain or Hotham
word of mouth
other
If other, please tell us where
I am happy to be contacted by email
If Yes, please provide your email address
I am happy to be contacted by phone
If Yes, please provide your phone number
I am happy to be contacted by post
If Yes, please provide your postal address
1000
characters left
I prefer to be contacted by
*
email
phone
post
Send
*
denotes required field
