Venue / Beeston Hockey Club, Highfields, Beeston, Nottingham
Date of event / Thursday 27& Friday 28 April 2017
Closing date for entries / Friday 24 February 2017
Please completeall sections in BLOCK CAPITALS. CSSC membership numbers must be included.You may find it helpful to‘Tab’ from one field to another.
Department/Organisation Represented:Section 1: Team Captain’s Details
TitleMrMrsMissMsDrOther / Forename: / Surname:GenderMaleFemale / Over 18:
Address (for communication)
Postcode
CSSC membership No.:
Staff / Payroll number::
Home Telephone No.: / Work Telephone No.
Fax No.: / Email
Next of Kin: / Contact Tel. Number:
Section 2: Team Details
Team Members Name: / CSSC Membership No.:1.
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Section 3: Entry fees
The entry fee for this event is £30.00 per team. Please make cheques payable to CSMHA and enclose with this form. (An electronic copy of the form should also be sent to Hilary Gray at CSSC Head Office – )
Section 4: Accommodation & Assistance with Funding
Accommodation is available at good group rates from Group Choice. Contact Barry Drain on 0161 366500 for more information.
Members not supported by their D.A. may be able to get help with expenses from their region. Check the CSSC Website, National Travel Policy for more information.
Section 5 Important Information
Medical: Please let us know if any member of your team has any physical or medical conditions. / Yes NoIf yes, please give details
Dietary: Please let us know if any member of your team has any special dietary requirements / Yes No
If yes, please give details
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 & Leisure Public Liability Insurance. Please note that this is not a Personal Accident Policy. Members are encouraged to take out their own insurance policy.
Please complete details forall team members. (If CSSC number is not available please substitute with full home address)
CONFIRMATION: Entries will be confirmed after the closing date. The playing schedule will be sent to Captains/Managers prior to the event.
Signed: Date:
Please send all entries and payment to:
Adrian Sims
218 Moseley Road,
Bilston
West Midlands
WV14 6JG
Tel: 07792 639322