ATHLETICS NEW SOUTH WALES

ENTRY FORM
 

EVENT

COUNTRY TRACK & FIELD CHAMPIONSHIPS

DATE

 

VENUE

 

ENTRY FEE

27Th, 28Th, 29Th January, 2012

 

Hunter Sports Centre, Stocklands Drive – Glendale

 

First Event $18.00 – (Club to pay) – Each additional event $8.00

 

NOTE: a cap of $65.00 applies for Families or an individual

 

PERSONAL INFORMATION

 

CLUB:     NOWRA

REGO NO:

FIRST NAME :

SURNAME:

DATE of BIRTH :

MALE / FEMALE:

ADDRESS:

TELEPHONE :          

Postcode:

EMAIL:

Please check website for draft timetable & important information

 

Age definition: Under 10 to open: Age you turn in 2O12.  Masters: Age on day

EVENT/ EVENTS ENTERED

Best Time for

lOOm to 800m

FEE

 

 

$18.00

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Total Amount

 
       
PAYMENT DETAILS & INFORMATION

Please fill in your personal details and Events you wish to Enter. Return the Form as soon as possible with the money for the second and subsequent events, i.e. $8.00 per event (Club is paying the $18.00 for your first event.)If paying by cheque, please make payable to Nowra Athletics Club. All forms & payment MUST be returned to Jan Gibb before the end of December.

 Amount Received…………………Cash / Cheque …Signature:………