Section 2: Regional Subsidy for Travel and Subsistence

Event / Midlands 8 Ball Pool Open Singles Competition 2017
Venue / Club 147, Wilton Street off Belgrave Gate, Leicester LE1 3HS
Date of event / Friday 24 March 2017
Closing date for entries / Friday 17 March 2017
Registration / 10.00 Start time: 10.30

This is a regional qualifying competition with the winner(s) being invited to attend the CSSC National Pool Final (providing the qualifying criteria is met).

Section 1: Details

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.

Title: / Forename: / Surname:
Gender: / Over 18: / Yes / No
Home Address
Postcode
CSSC membership no.
Staff/Payroll Number
Home Telephone no. / Work Telephone no.
Mobile Telephone no. / Email
Next of Kin / NoK Contact Tel. no.

Section 2: Regional Subsidy for travel and subsistence

All the Area Associations in the Midlands have signed up to provide competitors with financial help to attend CSSC Regional and National Open Events, please click here to see what you are entitled to claim or contact Ray Parker on 07951 341649 or email . Requests for assistance must be submitted no later than 3months after the event in question.

Section 3: Entry Fee

The entry fee is £6.00 per person which includes a buffet lunch

You can pay by Credit/Debit Card via calling 01494 888438

If you are paying by cheque please make it payable to CSSC Midlands

All standards of player are welcome. The competition is open to both ladies and men.

Section 4: Competitor Requirements

The competition is open to all full subscribing members of CSSC.

This event is also open to your friends or family members.As a reminder under our new Linked membership scheme, up to three of your friends or family members can join CSSC and take part in our events at members’ rates. 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. So, if you know someone that might be interested in this great event please spread the word.

Anyone who is not a subscribing member of CSSC and wishes to take part must obtain a membership application form which can be obtained from . If you are unable to quote your membership number please contact CSSC Head Office on 01494 888444

Section 5: Important Information

Medical: Please let us know if any member of your team has any physical or medical conditions

Yes/No (Delete as applicable)

If yes, please give details
Any 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 17 March 2017.Any enquires directly linked to the event please contact Phil Connolly –

Signed: Date:

Please send all entries to:

Post: Phil Connolly

2nd Floor

Howard House

Castle Meadow

Nottingham