disabled seating and wheelchair spaces booking form - Melbourne ...
disabled seating and wheelchair spaces booking form - Melbourne ...
disabled seating and wheelchair spaces booking form - Melbourne ...
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2012 Toyota AFL Gr<strong>and</strong> Final <strong>Melbourne</strong> Cricket Club Members Ballot<br />
Wheelchair, Accessible Seating <strong>and</strong> Companion Card Holders<br />
Name<br />
Address<br />
Suburb State Postcode<br />
Home phone Work phone Mobile<br />
Email address<br />
Examples of completed <strong>form</strong>s are overleaf<br />
Member Name<br />
Member Barcode Number<br />
Type of seat<br />
required?<br />
- One per member,<br />
enter “1” where<br />
required<br />
Wheelchair<br />
bay<br />
Reserved<br />
Seat<br />
Do you require a Companion Card or Carers Pass ticket?*<br />
*If required, member must have a Government issued Companion Card or an<br />
Authorised MCC Carers Pass, <strong>and</strong> provide the number below<br />
to be issued with an additional Reserved Seat ticket for their companion.<br />
Companion Card<br />
or<br />
Carers Pass ticket<br />
required? Y/N<br />
Companion card<br />
number *<br />
Authorised MCC<br />
Carers Pass * Y/N<br />
TOTAL NUMBER of WHEELCHAIR BAYS<br />
TOTAL NUMBER of RESERVED SEATS<br />
B<br />
Additional Member<br />
number<br />
(if applicable)<br />
TOTAL NUMBER of COMPANION/CARERS<br />
(A Reserved Seat Ticket will be issued)<br />
C<br />
TOTAL NUMBER OF PATRONS ATTENDING (A+B+C)<br />
(If successful in the ballot, this is the total of Reserved Seats / Bay tickets that will be issued for this request).<br />
A<br />
Ticket Value $25 per member<br />
* Members are permitted a maximum of 2 tickets per ballot registration; a member’s ticket <strong>and</strong> a complimentary ticket for either a Government issued<br />
Companion Card, an authorised MCC Carers Pass or an additional member/guest card.<br />
Please provide further details that we may require to allocate your tickets: (for example – medical conditions, limited stairs, etc...)<br />
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Once all registrations in the Ballot have been r<strong>and</strong>omised, tickets will be allocated accordingly.<br />
Attempts will be made to allocate successful members with ticket/s as per any extra details listed above, however this is not guaranteed.<br />
Applications must be received between 9am on Wednesday 22 August <strong>and</strong> 7pm on Monday 27 August 2012<br />
Please return your completed <strong>form</strong> to:<br />
Mail:<br />
Email: membership@mcc.org.au<br />
Club Operations Coordinator Fax: (03) 9650 5682<br />
<strong>Melbourne</strong> Cricket Club In Person: To the Membership Services Counter inside Gate 2<br />
PO Box 175, EAST MELBOURNE VIC 8002<br />
PAYMENT DETAILS (Visa / MasterCard / AMEX)<br />
Card Number<br />
Expiry Date<br />
CVC<br />
A registration fee of $5.00 per ticket (excl. Companion<br />
Card <strong>and</strong> MCC Carers Pass tickets) will be charged at<br />
the time of registration. If successful in the ballot, you<br />
will be charged the balance of the reserved seat<br />
charge ($20.00).<br />
If unsuccessful, the registration fee will be refunded.<br />
Card Holder _______________________________________ Signature _______________________________________<br />
OFFICE USE<br />
ONLY<br />
CID Section Row Seat/s<br />
MCC<br />
Auth
Example A: Member attending with a carer utilising the Companion Card entitlement. This member requires a <strong>wheelchair</strong> bay <strong>and</strong><br />
the assistance of a carer in a reserved seat.<br />
Member Name<br />
Member Barcode Number<br />
Type of seat<br />
required?<br />
- One per member,<br />
enter “1” where<br />
required<br />
Wheelchair<br />
bay<br />
Reserved<br />
Seat<br />
Do you require a Companion Card or Carers Pass ticket?*<br />
*If required, member must have a Government issued Companion Card or an<br />
Authorised MCC Carers Pass, <strong>and</strong> provide the number below<br />
to be issued with an additional Reserved Seat ticket for their companion.<br />
Companion Card<br />
or<br />
Carers Pass ticket<br />
required? Y/N<br />
Companion card<br />
number *<br />
Example A: Joe Bloggs 3215 4535 6542 1 Y X123456789/00<br />
TOTAL NUMBER of WHEELCHAIR BAYS A 1<br />
TOTAL NUMBER of RESERVED SEATS<br />
TOTAL NUMBER of COMPANION/CARERS<br />
(A Reserved Seat Ticket will be issued)<br />
B<br />
Additional Member<br />
number<br />
(if applicable)<br />
C 1<br />
Authorised MCC<br />
Carers Pass * Y/N<br />
TOTAL NUMBER OF PATRONS ATTENDING (A+B+C)<br />
(If successful in the ballot, this is the total of Reserved Seats / Bay tickets that will be issued for this request). 2 Ticket Value $25 per member<br />
Example B: Member attending with a carer utilising the MCC Authorised Carers Pass entitlement. This member requires an<br />
accessible seat <strong>and</strong> requires the assistance of a carer in a reserved seat.<br />
Member Name<br />
Member Barcode Number<br />
Type of seat<br />
required?<br />
- One per member,<br />
enter “1” where<br />
required<br />
Wheelchair<br />
bay<br />
Reserved<br />
Seat<br />
Do you require a Companion Card or Carers Pass ticket?*<br />
*If required, member must have a Government issued Companion Card or an<br />
Authorised MCC Carers Pass, <strong>and</strong> provide the number below<br />
to be issued with an additional Reserved Seat ticket for their companion.<br />
Companion Card<br />
or<br />
Carers Pass ticket<br />
required? Y/N<br />
Companion card<br />
number *<br />
Example B: Jane Smith 3215 4535 6542 56 1 Yes Yes<br />
Authorised MCC<br />
Carers Pass * Y/N<br />
TOTAL NUMBER of WHEELCHAIR BAYS<br />
A<br />
TOTAL NUMBER of RESERVED SEATS B 1<br />
Additional Member<br />
number<br />
(if applicable)<br />
TOTAL NUMBER of COMPANION/CARERS<br />
(A Reserved Seat Ticket will be issued)<br />
C 1<br />
TOTAL NUMBER OF PATRONS ATTENDING (A+B+C)<br />
(If successful in the ballot, this is the total of Reserved Seats / Bay tickets that will be issued for this request). 2 Ticket Value $25 per member<br />
Example C: Member attending who requires accessible <strong>seating</strong>, accompanied by another MCC member.<br />
Member Name<br />
Member Barcode Number<br />
Type of seat<br />
required?<br />
- One per member,<br />
enter “1” where<br />
required<br />
Wheelchair<br />
bay<br />
Reserved<br />
Seat<br />
Do you require a Companion Card or Carers Pass ticket?*<br />
*If required, member must have a Government issued Companion Card or an<br />
Authorised MCC Carers Pass, <strong>and</strong> provide the number below<br />
to be issued with an additional Reserved Seat ticket for their companion.<br />
Companion Card<br />
or<br />
Carers Pass ticket<br />
required? Y/N<br />
Companion card<br />
number *<br />
Example C: Tim Jones 3215 4535 6542 98 2 No<br />
(this member is attending with<br />
another member )<br />
TOTAL NUMBER of WHEELCHAIR BAYS<br />
A<br />
Authorised MCC<br />
Carers Pass * Y/N<br />
TOTAL NUMBER of RESERVED SEATS B 2<br />
Additional Member<br />
number 3215 4535 6555 68<br />
(if applicable)<br />
TOTAL NUMBER of COMPANION/CARERS<br />
(A Reserved Seat Ticket will be issued)<br />
C<br />
TOTAL NUMBER OF PATRONS ATTENDING (A+B+C)<br />
(If successful in the ballot, this is the total of Reserved Seats / Bay tickets that will be issued for this request). 2 Ticket Value $25 per member
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