Trick Your Triggers

Registration

Please complete the form below to confirm your weekend for Trick Your Triggers at 5th Ave Gooseberry Guest House in Linden, Johannesburg from Friday, 4 August – Sunday, 6 August 2023

I look forward to welcoming you!

Trick Your Triggers August 2023 Registration Form

Name

Surname

Cell phone Number

Address

Address Line 1

Address Line 2

City

Code

Province

Allergies or dietary requirements (Please note that there will be a possible extra charge for catering depending on the type of allergy or dietary requirement).

Next of kin's name and surname

Relationship

Next of kin's cell phone number

Kindly click the check boxes below before submission:

I understand that in order for my registration to be processed successfully I have to email my proof of payment to Susan Berry at info@gooseberry1.co.za

Indemnity:

I hereby irrevocably indemnify and hold harmless: 5th AVENUE GOOSEBERRY GUEST HOUSE, its owners, agents and employees against all and any actions, suits, proceedings, claims, demands, costs and expenses of whatsoever nature incurred from, any direct, indirect or consequential loss or damages I may suffer, and which may be taken or made against them or be incurred or become payable by them, arising out of my stay at the guest house.

I hereby certify and represent that I am over 18 years of age and have read the foregoing and fully understand the meaning and the effect thereof.

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