Online Registration

Have you had a full-on festive season over the past couple of months and are starting to fell the the affects of it?

If so, why not get 'On The Wagon' for a week and support Odyssey House - a leading alcohol, other drugs and gambling rehabilitation program.

The 'On The Wagon' campaign provides an opportunity for individuals to reflect on how alcohol affects the lives of so many in our community, whilst doing something positive to make a difference about the growing problem of alcohol misuse.

Each person who raises over $100 will receive an Odyssey House "On The Wagon" Tshirt! Please indicate your preferred size.

Please provide the following contact information:

First Name
Last Name
Title
Organisation
Street Address
Address (cont.)
Suburb
State
Postal Code
   
Phone
FAX
E-mail
URL

What type of registration is this:

Company Registration
 Individual Registration

My/Our colleagues, friends and family recognise my/our commitment to being 'On The Wagon' and have sponsored the following amount:

Date Amount
Sunday 5 February
Monday 6 February
Tuesday 7 February
Wednesday 8 February
Thursday 9 February
Friday 10 February
Saturday 11 February
Sunday 12 February

Total Amount Raised

*Anyone who raising over $100.00 will receive a free Odyssey House T-shirt!
Please indicate your preferred size:

Payment Details

Payment can be made by Cheque / Money Order made payable to Odyssey House McGrath Foundation or by credit card

Type of Card    Bankcard        Visa        MasterCard        Amex        Diners Club

Card number    / /  /                  Expiry /

Name on Card        Title 

Thank you for participating in 'On The Wagon'.

You'll not only be help yourself by feeling healthier, but you'll also make a difference by donating the money you would have spent on alcohol back to Odyssey House.