Please Indicate Which Event(S) You Wish to Take Part In
Venue / Atherley Indoor Bowls Club, Hill Lane, Southampton SO15 5DB
Date of event / Singles – 29 January.Pairs – 18 February,Triples–19 February
Closing date for entries / Singles26 JanuaryPairs & Triples16 February
Regional Qualifier, where the winners will receive an all expenses paid trip to the national finals. All of the events are open to both men and women – mixed teams are also welcome. Open to all subscribing members of CSSC. Entries from individual bowlers for teaming up into pairs and triples are welcome.
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:- 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 / Pairs SinglesTeam 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 / Pairs SinglesTeam Member3 (Delete as applicable)
Title: / Forename: / Surname:Gender: / Over 18: / Yes / No
Home Address
Postcode
CSSC membership no.
Staff/Payroll number.
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 / Pairs Singles2. Entry Fee
The entry fee is2.00per person per event
Payment can be made by credit/debit card - please ring Hilary Gray on 01494 888438 with details.
All cheques should be made payable to “CSSC South & Southeast” 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/payments from each team member
Total amount / £ / Payment method3. Competitor Requirements
The competition is open to all subscribingmembers of CSSC.
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.
This event is also open to your friends or family members.As a reminder under our Linked membership scheme, up to three of your friends or family members can join CSSC and take part in our events at member’s rates. 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.
4. Important Information
All three events start at 10.00 with registration from 09.30.
Competitors can received financial help to attend CSSC Regional Events, pleaseclick here to see what you are entitled to claim or contact the Events Team – . All claims must be made within3 months of the competition and receipts must be provided where applicable.
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 detailsAny 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 cheques are received and processed an acknowledgement will be made by email
Any enquires directly linked to the event please contact Dorian Bishop on (mob) 07761091968 – 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 ……………………………