Venue / Otterspool, Promenade, Merseyside, L17 5AR
Date of event / Wednesday 1st February 2017
Closing date for entries / Wednesday 18th January 2017
Start time / 9:00 (Fishing 10:30 – 15:00)
This event is the regional qualifier for the 2017National Finals in Wales!
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.
Section 1: Your Details (Delete as applicable)
Title: / Forename: / Surname:Gender: / Over 18: / No
Home Address
Postcode
CSSC membership 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£10 per person, however this will be reimbursed on participation.
Optional additional Pools £10- £2.50 flat fish, £2.50 round fish, £2.50 individual longest bag and £2.50 team, payable on the day to organiser.
To pay by card please call 01494 888407 quoting the name and date of the event.
All cheques should be made payable to ‘CSSC North West’ and should accompany the entry form. Please do not send cash.
Total amount enclosed: / Method of payment:• Anyone who is not a member of the CSSC and wants join can obtain a membership form from Rebecca Brand on 01494 888407 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.
North West
Section 3: Regional Subsidy for travel and subsistence
The North West 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. All claims must be made within3 months of the competition and receipts must be provided where applicable.
Section 4: Event Information
Meet at Jericho Lane car park, Otterspool at 9:00am – 9:30am
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 Nigel Conlon –
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 by18th January 2017.
Signed: Date:
Please send all entries and cheques to:
Post: Rebecca Brand
CSSC Sports & Leisure
Compton Court
20-24 Temple End
High Wycombe
Bucks
HP13 5DR
Contact: lephone: 01494 888407