Venue / World of Football @ Edinburgh Corn Exchange, 11 Newmarket Road, Edinburgh, EH14 1RJ
Date of event / Friday 3rd March 2017
Closing date for entries / Friday 10th February 2017
Registration/ Start time / 12:30/13:00
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.
Team Name:1. Team Captain’s Details (Delete as applicable)
Title: / Forename: / Surname:Gender: / Over 18: / Yes / No
Home Address
Postcode
CSSC membership no.
Staff payroll no.
Home Telephone no. / Work Telephone no.
Mobile Telephone no. / Email
Next of Kin / NoK Contact Tel. no.
Player 2 (Delete as applicable)
Title: / Forename: / Surname:Gender: / Over 18: / Yes / No
Home Address
Postcode
CSSC membership no.
Staff payroll.
Home Telephone no. / Work Telephone no.
Mobile Telephone no. / Email
Next of Kin / NoK Contact Tel. no.
Player 3 (Delete as applicable)
Title: / Forename: / Surname:Gender: / Over 18: / Yes / No
Home Address
Postcode
CSSC membership no.
Staff payroll no.
Home Telephone no. / Work Telephone no.
Mobile Telephone no. / Email
Next of Kin / NoK Contact Tel. no.
Player 4 (Delete as applicable)
Title: / Forename: / Surname:Gender: / Over 18: / Yes / No
Home Address
Postcode
CSSC membership no.
Staff payroll no.
Home Telephone no. / Work Telephone no.
Mobile Telephone no. / Email
Next of Kin / NoK Contact Tel. no.
Player 5(Delete as applicable)
Title: / Forename: / Surname:Gender: / Over 18: / Yes / No
Home Address
Postcode
CSSC membership no.
Staff payroll.
Home Telephone no. / Work Telephone no.
Mobile Telephone no. / Email
Next of Kin / NoK Contact Tel. no.
Player 6(Delete as applicable)
Title: / Forename: / Surname:Gender: / Over 18: / Yes / No
Home Address
Postcode
CSSC membership no.
Staff payroll no.
Home Telephone no. / Work Telephone no.
Mobile Telephone no. / Email
Next of Kin / NoK Contact Tel. no.
Player 7(Delete as applicable)
Title: / Forename: / Surname:Gender: / Over 18: / Yes / No
Home Address
Postcode
CSSC membership no.
Staff payroll no.
Home Telephone no. / Work Telephone no.
Mobile Telephone no. / Email
Next of Kin / NoK Contact Tel. no.
Section 2: Entry Fee
The entry fee is £35 per team
Payment can be made by debit/credit card – telephone Matthew Taylor on 01494 888439 with details.
All cheques should be made payable to CSSC Scotland and should accompany the entry form. Please do not send cash. CSSC is happy to accept one cheque for the full team cost or individual cheques from each team member.
Total amount enclosed: / £ / Method of Payment• Anyone who is not a member of the CSSC and wants join can obtain a membership form from Matthew Taylor on 01494 888439 or the organiser (if different). If you are unable to quote your CSSC number e.g. lost card, a form for a replacement card can be found online or please contact our customer services team on 01494 888444.
Section 3: Regional Subsidy for travel and subsistence
The Scotland 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 Philip Oldbury via email . All claims must be made within3 months of the competition and receipts must be provided where applicable.
Section 4: Event Information
Don’t forget that this event is also open to your friends or family members. Under our Linked membership scheme, up to three of your friends or family members can join CSSC and take part in our events. 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.
Any queries to the event organiser
Any enquires directly linked to the event please contact Stuart MacDonald on 07500871502 or via email
Section 5: Important Information
Medical: Please let us know if you have 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 10th February 2017.
Signed: Date:
Please send all entries and cheques to:
Post: Matthew Taylor
CSSC Sports & Leisure
Compton Court
20-24 Temple End
High Wycombe
Bucks
HP13 5DR
Contact: Telephone: 01494 888439