In the name of Allah, the Compassionate, the Merciful ADDRESS

POSTAL
FAMSY (VICTORIA) PO Box 451, Newport VIC
3015
GENERAL ENQUIRIES
Rifat 0431526748
BROTHERS CAMP END OF YEAR 2008– REGISTRATIONBasil
FORM 0422 851 108
Ahmed 0447276063
E-MAIL
PARTICIPANT NAME ___________________________________
rifatislam@hotmail.com
omar.lahham@hotmail.com
WEBSITE
ADDRESS ___________________________________
www.famsy.com

HALAQAH GROUP (if applicable) ___________________________

will be attending YOUTH CAMP – END OF YEAR 2008, ANGLESEA

organised by FAMSY VICTORIA.

from 10.00 am 28/11/2006 to 7.00 pm 30/11/2006

cost $AUD 119 (covers transport, venue, accomodation, food &

activities)

Health / fitness aspects that may need special attention, including

allergies ______________________________________________

Other Participant Details:

PARTICIPANT MOBILE PHONE NUMBER______________________________

PARTICIPANT EMAIL ADDRESS _____________________________________

PARTICIPANT MEDICARE NUMBER __________________________________

IF NEW TO FAMSY: WOULD YOU BE INTERESTED IN ATTENDING AN ISLAMIC

STUDY CIRLE? Y / N (circle)

IN CASE OF EMERGENCY, CONTACT (name)___________________________

TELEPHONE NUMBER:______________________________________________

I authorise any volunteer or member of FAMSY Inc, Victoria Chapter, in the event of any accident or
illness to obtain such urgent medical assistance or treatment for the above named youth member,
including the administration of any anaesthetic or blood transfusion as he or she may consider
expedient and for this purpose to engage any first aides, ambulance officers, doctors, dentists, nursing
assistance or hospital accommodation and in this event I agree to pay the said Association on demand
all such doctors', dentists’, nurses', ambulance and hospital fees (other than fees and expenses
recoverable by the said Association under any policy of insurance). I also agree not to hold FAMSY or
any of their volunteers liable for accidents or injury that may arise during the camp.

SIGNED____________________________
PRINT NAME________________________DATE__________________________

Note: Please deposit the camp attendance fee at

Commonwealth bank
BSB: 063 112
ACCOUNT#: 10258470
Federation of Australian Muslim students and youth

Please put your Name as Reference for the deposit.