BOCCIA ENGLAND REGIONAL

CHAMPIONSHIPS ENTRY FORM 2013 - 2014

Dates & Venues

South East: / Sunday 17th November 2013 / Surrey Sports Park, University of Surrey
Midlands: / Saturday 30th November 2013 / Lee Westwood Sports Centre, Nottingham Trent University
North West: / Sunday 1st December 2013 / Kirkby Sports College, Kirkby
North East: / Tuesday 3rd and Wednesday 4th December 2013 / Percy Hedley, Newcastle
East: / Saturday 18th January 2014 / Colchester Garrison,
Colchester
London: / Sunday 19th January 2014 / SportsDock, University of East London
South West: / Saturday 1st February 2014 / Riverside Leisure Centre,
Exeter
West: / Sunday 2nd February 2014 / Leisure@Cheltenham,
Cheltenham
Name:
Male/Female: / Date of Birth:
Full Address:
Postcode: / Email:
Tel. Number: / Club/School/Ind

Classification: If you have previously been classified at a Boccia event please indicate which classification you compete in:

BC1/Class 1 BC4/Non CP thrower

BC2/Class 2 BC3/With Assistive Device

If you have never been classified, please provide us with some brief information to assist our classifiers (i.e. diagnosis – Cerebral palsy, muscular dystrophy etc, use a ramp to play or any other information you think may be of use)______

______

______

*Players that have not previously been classified will be classified on the morning of the competition – further information about this will be sent with your confirmation letter.

Boccia England practices a policy of equitable provision of goods and services to all groups. Please help us monitor who is receiving services by filling in the following information:
What is your ethnic group?
White or white British □ / Black or Black British □ / Other Black
Black Caribbean □
African □
Other Black □
Mixed
White & Black Caribbean □
White & Black African □
White & Asian □
Other Mixed □ / Chinese or Other Ethnic Group
Chinese □
Other Ethnic Group □
Asian or Asian British
Indian □
Pakistani □
Bangladeshi □
Other Asian □ / Prefer not to say □
Unknown □

Entry Fee: Members: £9 Non-Members: £15.00

Entries MUST arrive 2 weeks prior to the competition date!

Please return this form along with a cheque (payable to “Boccia England”) to:

Boccia England, 8 Heathcoat Building, Nottingham Science Park, University Boulevard, Nottingham, NG7 2QJ.

e: t: 0115 9678455