Venue / Rileys Snooker Club, 17A St James Street, Nottingham, NG1 6FH
Date of event / Friday 2 December 2016
Closing date for entries / Friday 18 November 2016
Registration / 9.45am Start time: 10.00am
The event will comprise of singles and double competitions
Section 1: Details
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.
Competitors can play singles or doubles or both. If you do not have a partner but wish to play doubles please advise the organiser accordingly.
Player One
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.
Player Two
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.
Section 2: Regional Subsidy
The Midlands Region have signed up to provide competitors with financial help to attend CSSC Regional Events, please click here to see what you are entitled to claim or contact Ray Parker via email . All claims must be made within3 months of the competition and receipts must be provided where applicable.
Section 3: Entry Fee
The entry fee is £2.00 per person.(Riley’s will be providing a £4 food voucher)
You can pay by Credit/Debit Card via calling 01494 888438
If you are paying by cheque please make it payable to CSSC Midlands
All standards of player are welcome and is open to both men and ladies.
Section 4: Competitor Requirements
The competition is open to all full subscribing members of CSSC.
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 members’ 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. So, if you know someone that might be interested in this great event please spread the word.
Anyone who is not a subscribing member of CSSC and wishes to take part must obtain a membership application form which can be obtained from . If you are unable to quote your membership number please contact CSSC Head Office on 01494 888444
Section 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 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 organiser’s decision on all matters is final. All entries to be received by Friday 9 October 2015.Any enquires directly linked to the event please contact Nigel Daniels:
Signed: Date:
Please send all entries to:
Post: Nigel Daniels
HMRC Trusts and Estates,Heritage team, 2nd Floor, Ferrers House, Castle Meadow Road,
Nottingham NG2 1BB
Contact: Nigel Daniels: 03000562443