Venue / The Ballroom, 130 Ledard Road, Glasgow G42 9RA
Date of event / Friday 28 April 2017– Registration from 11.30 a.m. for 12:00 start
Closing date for entries / Thursday 27 April 2017
Winner of this event will be invited to represent the Scotland Region at the CSSC National Pool Finals in Birtley on 2-3 June 2017- all expenses paid (providing the qualifying criteria is met)
Please completeall sections in BLOCK CAPITALS. CSSC membership numbers must be included.You may find it helpful to‘Tab’ from one field to another.
Section 1: Details
Player One
Title: / Forename: / Surname:Gender: / Over 18: / Yes / No
Address (for communication)
Postcode
CSSC membership No.:
Staff / Payroll Number:
Home Telephone No.: / Work Telephone No.
Fax No.: / Email
Next of Kin / NoK Contact Tel. no.
Section 2: Entry Fee
The entry fee is £3.00 per person.
Payment can be made by debit/credit card – just ring Hilary Gray on 01494 888438
All cheques should be made payable to“CSSC Scotland”and should accompany the entry form. Please do not send cash
Total amount: / £ / Payment method:Section 3: Regional Subsidy
All CSSC Regions have signed up to provide competitors with financial help to attend CSSC Regional and National Open Events, please click here to see what you are entitled to claim or email the CSSC Events team on
Section 4: Competitor Requirements
The competition is open to all full subscribing members of CSSC.
This event is 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 members’ 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.
If you do not know your CSSC number please contact our membership department on 01494 888443.
If you require a form to sign up a new member please contact Hilary on 01494 888438 or
Section 5: Important Information
This event is played to Blackball Rules.
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 detailsIMPORTANT: 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 payments are received an acknowledgement will be sent out by email.
Any enquires directly linked to the event please contactRobert Gillies on 07981 247973 or
Signed: Date:
Please send all entries and cheques to:
Post: Hilary Gray
CSSC Sports & Leisure
Compton Court
20-24 Temple End
High Wycombe
Bucks
HP13 5DR
Contact:
01494 888438