ABN: 65 861 621 504
Pot Plants Entry Form
Exhibitor Full Name
If under 18 Parent/ Guardian Name
Postal Address
Phone
Email
Are you registered for GST?
Cls
No
80
81
82
83
84
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Class Name
Hanging Fern
Adiantum (Maiden Hair) - small
Adiantum (Maiden Hair) - large
Nephrolepis
Fern or Alli - Any Other Variety
Native Fern
Anthurium
Aglaonema
Alocasia
Begonia
Dieffenbachia
Dracaena
Maranta
Peperomia - Small Leaf
Peperomia - Large Leaf
Philodendron
St Paulia
Cacti or Succulent
Zygo Cactus in bloom
Bromeliad
Plant Any Other Variety - sml
Plant Any Other Variety - large
Mobile
If yes, please provide your ABN:
Sample Size
Pot <15cm
Pot >15cm
Pot <15cm
Pot >15cm
Flowering Plant
Tillandsia
Bonsai
Kalanchoe
No x
Exh
Cls
Fee
$0.20
$0.20
$0.20
$0.20
$0.20
$0.20
$0.20
$0.20
$0.20
$0.20
$0.20
$0.20
$0.20
$0.20
$0.20
$0.20
$0.20
$0.20
$0.20
$0.20
$0.20
$0.20
$0.20
$0.20
$0.20
$0.20
Exh
No(1)
Exh
No(2)
Exh
No(3)
Exh
No(4)
Total
Fees
 Please pay my prizemoney directly to my bank account.
BSB: __ __ __ __ __ __ Account No: __ __ __ __ __ __ __ __ __ __ __ __
Name of Acct: __ __ __ __ __ __ __ __ __ __ __ ____ __ __ __ __ __ __ __
*Prizemoney not collected by 30th September will be deemed a donation to the Show Society.
I hereby certify that my Entries are my bona fide property/my own original work and that I have read the Show Rules and the
Conditions of Entry and agree to be bound thereby:
Signature……………………………..…………………………...…………………...…… Date………………………………………...……………
Office Use Only
Served by
Paid
$
Carded by
Receipt #
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