2017/18 NSW Country Club Championships - Team Entry Form
The NSW Country Clubs to be held in Newcastle Friday 26 - Sunday 28 January 2018.

**Please submit ONE form for each team**

This entry form must be completed in full and received by Water Polo NSW before close of business Friday, 8th December 2017. Late entries will only be accepted at the discretion of WPNSW.

Team Entry Fee - $750 inc GST

Team Entry is due and payable before close of business Friday, 22nd December 2017. Please ensure reference details are included on all payments e.g. 'Club' Country Clubs.

Any questions please email events@waterpolonsw.org.au

Email address *
Team Entry Details
District / Region *
Club Name *
Team Name *
Your answer
Gender *
Divison *
Team Official Details
Team Manager's Name *
Your answer
Team Manager's Email *
Your answer
Team Managers Mobile *
Your answer
Club Official Details
Club Official Submitting Forms *
Your answer
Club Official Position *
Your answer
Club Official Email *
Your answer
Club Official Mobile *
Your answer
Team Entry Submission Statement
In submitting this form for the 2017/18 NSW Country Club Championships, I agree, on behalf of the Club, to the Conditions of Entry (http://websites.sportstg.com/assoc_page.cgi?c=1-3209-0-0-0&sID=399955) and that all team entry fees will be paid prior to the commencement of competition.
A copy of your responses will be emailed to the address you provided.
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