Event / CSSC Scotland – Scottish Darts (North)
Venue / Sands Bar, 3 Ware Road, Peterhead, AB42 1NQ
Date of event / Sunday 6 May 2018 – Registration 12:00 for a 13:00 start
Closing date for entries / Monday 30 April 2018

Regional Qualifier, where the top team and winning singles player will receive an all expenses paid trip to the CSSC national finals. You can only qualify for the team or the singles,not both (providing the entry criteria has been met).

ALL ENTRIES MUST BE SENT TO HEAD OFFICE. NO ENTRIES WILL BE TAKEN ON THE DAY.

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.
Staff / Payroll no .
Home Telephone no. / Work Telephone no.
Mobile Telephone no. / Email
Next of Kin / NoK Contact Tel. no.

Please indicate which event(s) you wish to take part in.

Triples / Singles

Team Member2 (Delete as applicable)

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

Please indicate which event(s) you wish to take part in.

Triples / Singles

Team Member3 (Delete as applicable)

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

Please indicate which event(s) you wish to take part in.

Team / Singles

2. Entry Fee

The entry fee is£5.00per person.

Payment can be made by credit/debit card - please telephone Hilary Gray on 01494 888438 with the details.

Any payment by cheque should be made payable to “CSSC Scotland” and should accompany the entry form. Pleasedo 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:

3. Competitor Requirements

The competition is open to all full subscribingmembers of CSSC.

This event is also open to your friends or family members.As a reminder under our new Linked membership scheme, up to three of your friends or family members can join CSSC and take part in our events. Membership is also available to staff working in the Public Sector such as NHS, local government, teachers, the police, fire fighters and HM Armed forces personnel.

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

Section 4: National Travel Policy

All CSSC Regions have signed up to provide competitors with financial help to attend CSSC Regional and National Open Events, please click here to see what you are entitled to claim or email the CSSC Events team on . All claims must be made within3 months of the competition and receipts must be provided where applicable.

Section 5: Important Information

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

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 organisers decision on

all matters is final. All entries to be received byHilary Gray.

Once entry forms and payment are received an acknowledgement will be made by email.

Any enquires directly linked to the event please contact Allan Stephen on 07596 488593 or email

Signed: Date:

Please send all entries and cheques to:

Post: Hilary Gray

CSSC Sports & Leisure

Compton CourtPhotocopies forms will be accepted

20-24 Temple End

High Wycombe

Bucks

HP13 5DR

Contact:

01494 888438

Date Received ……………………………… Acknowledgement sent ……………………………