Event / South West Skittles Competition 2017
Venue / Bristol Civil Service Club – BS7 0AT
Date of event / Sunday 9th April 2017
Closing date for entries / Friday 31st March 2017

This is a regional qualifying tournament for the CSSC Skittles National Final to be held at the Cheltenham CS Club. The winning team will be invited to attend the tournament with all expenses paid (providing the qualifying criteria are met).

Please complete all sections in BLOCK CAPITALS. CSSC membership numbers must be included. You may find it helpful to ‘Tab’ from one field to another.

Team Name:

1. Team Captain’s Details (Delete as applicable)

Title: / Forename: / Surname:
Gender: / Over 18: / Yes / No
Home Address
Postcode
CSSC membership no.
Home Telephone no. / Work Telephone no.
Mobile Telephone no. / Email
Next of Kin / NoK Contact Tel. no.

Team Member 2 (Delete as applicable)

Title: / Forename: / Surname:
Gender: / Over 18: / Yes / No
Home Address
Postcode
CSSC membership no.
Home Telephone no. / Work Telephone no.
Mobile Telephone no. / Email
Next of Kin / NoK Contact Tel. no.

Team Member 3 (Delete as applicable)

Title: / Forename: / Surname:
Gender: / Over 18: / Yes / No
Home Address
Postcode
CSSC membership no.
Home Telephone no. / Work Telephone no.
Mobile Telephone no. / Email
Next of Kin / NoK Contact Tel. no.

Team Member 4 (Delete as applicable)

Title: / Forename: / Surname:
Gender: / Over 18: / Yes / No
Home Address
Postcode
CSSC membership no.
Home Telephone no. / Work Telephone no.
Mobile Telephone no. / Email
Next of Kin / NoK Contact Tel. no.

Team Member 5 (Delete as applicable)

Title: / Forename: / Surname:
Gender: / Over 18: / Yes / No
Home Address
Postcode
CSSC membership no.
Home Telephone no. / Work Telephone no.
Mobile Telephone no. / Email
Next of Kin / NoK Contact Tel. no.

Team Member 6 (Delete as applicable)

Title: / Forename: / Surname:
Gender: / Over 18: / Yes / No
Home Address
Postcode
CSSC membership no.
Home Telephone no. / Work Telephone no.
Mobile Telephone no. / Email
Next of Kin / NoK Contact Tel. no.

Team Member 7 (Delete as applicable)

Title: / Forename: / Surname:
Gender: / Over 18: / Yes / No
Home Address
Postcode
CSSC membership no.
Home Telephone no. / Work Telephone no.
Mobile Telephone no. / Email
Next of Kin / NoK Contact Tel. no.

Team Member 8 (Delete as applicable)

Title: / Forename: / Surname:
Gender: / Over 18: / Yes / No
Home Address
Postcode
CSSC membership no.
Home Telephone no. / Work Telephone no.
Mobile Telephone no. / Email
Next of Kin / NoK Contact Tel. no.

2. Entry Fee

The entry fee is £20 per team.

Each team can register up to 8 players but only six player compete in each game.

Payment can be made by debit/credit card by contacting Rebecca Brand on 01494 888407 and quoting the name and date of the event.

All cheques should be made payable to “CSSC Southwest” and should accompany the entry form. Please do not send cash. CSSC is happy to accept one cheque for the full team cost or individual cheques from each team member.

Total amount: / £ / Payment method:

South West

Section 3: Regional Subsidy for travel and subsistence

The South West Region have signed up to provide competitors with financial help to attend CSSC Regional Events, please click here to see what you are entitled to claim. All claims must be made within3 months of the competition and receipts must be provided where applicable.

4. Important Information

All team members must be full subscribing members of the CSSC.

Registration time: 1pm, Start time: 1:30pm

Team event (Male, female or mixed)

If you wish to play in this tournament but are not a member of the team please contact the organiser, John West, as there may be others in a similar position.

Medical: Please let us know if any member of your team has any physical or medical conditions

Yes/No (Delete as applicable)

If yes, please give details
Any Dietary Requirements

Anyone who is not a subscribing member of CSSC and wishes to take part must obtain a membership application form. If you are unable to quote your membership number please contact CSSC Head Office on 01494 888444.

IMPORTANT: These events are active and players should be aware of the physical activities involved. CSSC reserves the right to cancel the event if under subscribed.

All CSSC members taking part in the event are covered by CSSC Sports and Leisure Public Liability Insurance. Please note that this policy is NOT a Personal Accident Policy. Members are encouraged to take out their own insurance policy

The organiser reserves the right to cancel any event if there are insufficient entries. The organiser’s decision on all matters is final.

All entries and payments are to be sent to Rebecca Brand at Head Office (address below).

Any enquires directly linked to the event please contact John West on 07971 779502 or e-mail

Signed: Date:

Please send all entries and cheques to:

Post: Rebecca Brand

CSSC Sports & Leisure

Compton Court

20-24 Temple End

High Wycombe

Bucks

HP13 5DR

Contact: Tel: 01494 888407