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
PLAYER 1 *
(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
PLAYER 2 *
Your answer
PLAYER 3 *
Your answer
PLAYER 4
Your answer
Do you require a postal address in order to make a cheque payment? *
Required
Additional information, question or comment
e.g. confirm payment and method (Bank Transfer or Cheque by Post)
Your answer
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.