This Event Is Open to Both Men and Ladies. the Winner of Each Event Will Be Invited To

Event / North East Joint Snooker and 8 Ball Pool Tournament
Venue / Birtley Snooker and Pool Club, 1st Floor, Durham Road, Birtley, DH3 2PS
Date of event / Saturday 11 March 2017
Closing date for entries / Tuesday 28 February 2017
Registration/ Start time / 11:30 for 12.00 start

This event is open to both men and ladies. The winner of each event will be invited to represent the North East Region at the relevant National Final (all expenses paid) – providing the qualifying criteria is 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.

Section 1: Your Details (Delete as applicable)

Title: / Forename: / Surname:
Gender: / Over 18: / 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.

Section 2: Entry Fee

The entry fee is £5 and gives entry to both snooker and pool.

To pay by card please call 01494 888438

All cheques should be made payable to ‘CSSC North East’ and should accompany the entry form. Please do not send cash.

Total amount enclosed: / Method of payment:

Section 3: Event Information

Don’t forget that this event is also open to your friends or family members. Under our 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 member of the CSSC and wants join can obtain a membership form from Hilary Gray on 01494 888438 or the organiser (if different). If you are unable to quote your CSSC number e.g. lost card, a form for a replacement card can be found online or please contact our customer services team on 01494 888444.

Any queries to the event organiser

Any enquires directly linked to the event please contact Paul Henderson on 07867915072 or e-mail

Section 4: Regional Subsidy

The North East 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 or contact Garry Lindsay via email . 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 you have 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 organiser’s decision on all matters is final. All entries to be received by28 February 2017.

Signed: Date:

Please send all entries (emailed forms are also accepted if payment is made by card) and cheques to:

Post: Hilary Gray

CSSC Sports & Leisure

Compton Court

20-24 Temple End

High Wycombe

Bucks

HP13 5DR

Contact:

Telephone: 01494 888438