Event / Mixed Netball Tournament 2018
Venue / Brunel University Sport Centre (outdoor netball courts), Brunel University London, Uxbridge, UB8 3PW
Date of event / Sunday 10th June 2018
Closing date for entries / Friday 4th May 2018
Registration/ Start time / 9:30/10:00

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.

Each team must consist of a minimum of 7 players and a maximum of 12 players.

There must be at least two members of each sex on court during a game.

(All players must be CSSC members)

Section 1: Team’s Details (Delete as applicable)

Team Name:

Player 1

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

Player 2

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

Player 3

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

Player 4

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

Player 5

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

Player 6

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

Player 7

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

Player 8

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

Player 9

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

Player 10

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

Player 11

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

Player 12

Title: / Forename: / Surname:
Gender: / Over 18: / No
Home Address
Postcode
CSSC membership 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 £50 per team

The price includes a pack lunch (please state any dietary requirements on the next page).

To pay by card please call 01494 888407, quote the name and date of the event.

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

Total amount enclosed: / Method of payment:

• Anyone who is not a member of the CSSC and wants join can obtain a membership form from Rebecca Brand on 01494 888407 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.

Section 3: National Subsidy for travel and subsistence

All CSSC Regions have signed up to provide competitors with financial help to attend CSSC National Open Events, please click here to see what you are entitled to claim or email the CSSC Events team on

Costs for use of a private car are assessed on the basis of mileage and fuel type and will be as follows:

·  Driver - 50% of mileage costs up to one times the current full annual CSSC subscription;

·  Passengers – 5p per mile up to a maximum of £15 per passenger.

·  Costs for use of public transport will be 50% of costs up to one times the current full annual CSSC subscription;

If overnight accommodation is booked centrally by CSSC HO then CSSC will provide the cost figure to be assumed for rebate purposes. If you book your own accommodation then that is the cost for claim purposes but if you book your own accommodation independently of a CSSC offering then that must be justified. Costs will be as follows:

·  For each night only 50% of the cost up to a maximum of the current full annual CSSC subscription; subject to a maximum claim for any one event of two times the current full annual CSSC subscription.

Section 4: Event Information

The tournament will take place on outdoor courts, so please bring appropriate clothing.

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.

Any queries to the event organiser

Any enquires directly linked to the event please contact Sharon Finan on

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 by Friday 4th May 2018.

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: Telephone: 01494 888407