Regional Qualifier, Where the Winners Will Receive an All Expenses Paid Trip to the National

Event / CSSCEastern Indoor Bowls TriplesTournament 2018
Venue / Chesterton Indoor Bowls Club, Cambridge
Date of event / Saturday 27 January 2018
Closing date for entries / Friday 16 December 2017

Regional Qualifier, where the winners will receive an all expenses paid trip to the national finals (providing the qualifying criteria is met). 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 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 Alternative Home Contact Tel. no.

Team Member2 (Delete as applicable)

Team Member 3 (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 Alternative Home Contact Tel. no.

2. Entry Fee

The entry fee is£18.00 per person which includes lunch and tea. Triples can be either gender or mixed

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 Eastern” 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 method:

3. Competitor Requirements

The competition is open to all subscribingmembers of CSSC who work or reside within the region.

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 new Linked membership scheme, up to three of your friends or family members can join CSSC and take part in our events at a member’s rate. 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.

Section 4: Regional Subsidy

The Eastern Region have signed up to provide competitors with financial help to attend CSSC Regional Events, please click hereto see what you are entitled to claim or contact the Event Team at Head office via email

All claims must be made within3 months of the competition and receipts must be provided where applicable.

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 by Hilary Gray

For any enquiries directly linked to the event please contact Joy Kent on 01487 841371 or 07980 118726. Email

Signed: Date:

Please send all entries and cheques to:

Post: Hilary Gray

CSSC,

Compton Court,

20-24 Temple End

High Wycombe

Bucks

HP13 5DR

Email:

Telephone: 01494 888438

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