St Kilda Shield

Name: ________________________________________________________
Address: ________________________________________________________
  __________________________________ Postcode:____________
Occupation: ________________________________________________________
Date of Birth: ________________________________________________________
Tel (H): __________________________ (W): _________________________
Fax: __________________________
Favourite Player: ________________________________________________________





Category Price Total
 

Interstate $36.00 (Adults) ________
  $18.00 (Children) ________
  $26.00 (Concession) ________
  $60.00 (Family) ________
  TOTAL ________


Please return with payment to the official St Kilda Football Club Support Group in your region. Cheques to be made payable to your supporter group.


Canberra St Kilda Supporters Club
GPO Box 1850
Canberra ACT 2601