Register for the Duncan Cotterill Business Lunch

Use this form if you want to pay for your ticket(s) online by credit card. (If you want to pay by off-line means, please exit this form and go back to the emailed invitation.) Fill in the details below, calculate the cost of all tickets, and authorise us to debit your credit card by this amount.

The cost (which includes GST) is:
$95.00 per individual, or
$850.00 per table of 10 people

NOTE: This form is transmitted using high-level industrial encryption and a secure server, so your credit card details cannot be intercepted and abused.


Your name:
Name of your business or organisation:
Postal address:
Email address:
Contact phone:
Number of places :	I wish to purchase individual places ($95 per person) OR I wish to purchase tables of 10 ($850 per table)
Calculated payment for these places:	$
CREDIT CARD DETAILS: Please debit my credit card for the amount matching my ticket requirements (click to accept).
Card type:
Card number:
Card holder's name:
Expiry date:	/