Middlesex Merit Table Entry Form

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Please use this form to enter a team or teams from your club in the Middlesex Merit Table league or Merit Table knock out competition for the 2016 - 2017 season.

The cut off date for entering the Merit Table is Sunday 5th June 2016.

Club Details

Club Name *

Ground Address *

Merit Table League Entry

We wish to enter the following side(s) in the 2016 - 2017 Merit Table league. You may enter more than one team.

Team Name 1 (MMT League)

Team Name 2 (MMT League)

Team Name 3 (MMT League)

Team Name 4 (MMT League)

Merit Table Knock Out Competition Entry

We wish to enter the following side(s) in the 2016 - 2017 Merit Table knock out competition. You may enter more than one team. Only teams playing in the main compeittion are eligible to enter the MMT knock out competition. (Leave blank if you do not with to enter the knock out competition)

Team Name 1 (MMT Knock Out Competition)

Team Name 2 (MMT Knock Out Competition)

Team Name 3 (MMT Knock Out Competition)

Team Name 4 (MMT Knock Out Competition)

Contact Details

All information regarding the MMT and knock out competition will be sent to the email address given below

Name *

Position in Club *

Mobile number *

Email address *

Middlesex Rugby

PK1, Twyford Avenue Sports Ground, Twyford Avenue, Acton, London W3 9AQ
T: 020 8896 3400 Email: countyoffice@middlesexrugby.com
www.middlesexrugby.com

Middlesex Rugby will not pass on or share any information submitted via this form with any third parties.

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