Scott Kirkbride Melanoma Research Centre (SKMRC)
The SKMRC Annual Luncheon 2012
  

As the Scott Kirkbride Melanoma Research Centre is a centre within the Western Australian Institute for Medical Research, all ticket purchases will be made through WAIMR.

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*Number of Tickets :  at $160 each
 
*Corporate Tables :  at $1600 per table
 

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