Australian Indoor Qualifying Entry Form

by admin

Indoor Qualifying Entry Form
20th-22nd April 2018
Howrah Bowls Club
11 Howrah Rd, Howrah
            Preferred date: Friday 20th from 6pm ☐; Saturday 21st from 9am ☐; Sunday 22nd from 9am ☐
Entrant Details
First Name*           Surname*
E-mail*

Contact Number*                    
Club*                                     
Payment Details
Entry Fee: $30
Cheques should be made out to Bowls Tasmania. 
Direct Debit can be made to; BSB Number: 633-000 Account Number: 130805310 Mark Payment “IQ18”
If paying by credit card, please complete the below details.
Name on Card     
Card Type                     ☐   MASTERCARD   ☐   VISA
Card Number      
Expiry Date                             CSV         
Signature 
 
Waiver
Paper Entries close at 5pm Tuesday 17th April 2018.  Any entries received after this date will not be accepted.  Entry is not complete unless accompanied with full payment and all mandatory fields are completed.  Bowls Tasmania will email written confirmation once entries are confirmed.
I confirm that I am eligible to participate in the event as per the Conditions of Play and agree that all information provided is true and accurate and will be used by the event management for the purposes of Bowls Tasmania related activities.
Signed*         Date
If under 18, a parent or guardian must complete the below details.
First & Last Name Signature