Regional Qualifiers 2019 ENTRY Form

Entry Deadline : NOON on Sunday 31 March

RQ1 : Sunday 28 April at Lincoln Branleys PC, LN1 2BE
RQ2 : Sunday 19 May at The Air Hostess, Tollerton NG12 4EA
RQ3 : Sunday 09 June at Leicester Banks PC, LE2 8HA
RQX (if required) : 23 Jun

Registration : 08h40 to 09h00 at each event

Entry fees: £15 per player (£45/£60 per team) for the competition series

Please pay by internet transfer or bank giro credit to
East Midlands Petanque Association
NEW Bank Sort Code : 30-96-26 and Account Number : 24367468

Please include the letters 'RQ' and (part of) your Team name as a reference
Keep your on-line or branch receipt in a safe place
Giro payments should be made no later than Tue 26 March
For cheques by post, request address in Form

Team Name *
Your answer
(Contact person for team, names to match licenses please)
Your answer
Email address *
Your answer
Mobile no *
Please insert a space character after 5 digits, like this : 07700 900378
Your answer
Your answer
Your answer
Your answer
Do you require a postal address in order to make a cheque payment? *
Additional information, question or comment
e.g. confirm payment and method (Bank Transfer or Cheque by Post)
Your answer
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