Officiating Your Ceremony, for You 
Bill Scurry
ACMC., JP(Qual)., Dip.Theol., Dip.C.W (Adv)
International Phone:   61 7 5441 3474
Mobile: 0404 394 500 
Web Site: www.bcscurry.com
By cheque, please make payable  to WJ & CA SCURRY 
If using Direct Deposit, then please note Bendigo Bank account details: 
WJ & CA SCURRY    BSB  633 000    Acc No.  121681183

    Confirmation of Booking
               Please print, then complete and return this Form
             with the deposit as set out below, to:
Bill Scurry    PO Box 5309    Maroochydore BC    Queensland  4558

 GROOM’s Name:

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 BRIDE’s Name:

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                  “Thank You for allowing me to be a part of Your Special day”
 
  DEPOSIT INCLUDED:  $                                     DATE: 
   SIGNING AND RETURNING THIS FORM, CONFIRMS OUR ACCEPTANCE OF THE ABOVE CONDITIONS 

  SIGNED:   Bride:                                              Groom:
 

Email:

 Email:

 Home Phone-
 Mobile #

Home Phone-
Mobile #

Address: ………………………………………………

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 Address: …………………………………………………

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