Registration Form
Please use this form to register for the New Zealand National U15 & U17 Championships 2018, which will be held at Wellington High School’s Upper and Lower Gyms, Taranaki Street, Wellington on 21-23 April 2018

Entries close at 5pm on Wednesday 18 April 2018.

Please read through the competition information sheet carefully before you complete the form below:
https://drive.google.com/open?id=1gkM16sPvS6MzFP8tdjjWSTKHEd5C3Opa

Female U15 and U17 fencers: FENZ are trialling important changes to the competition format. Please familiarise yourself with those changes before you complete this form.

For help with this form or any queries please email Jo Little on littleassoc@gmail.com

Email address *
Surname *
Your answer
First name *
Your answer
Date of birth *
MM
/
DD
/
YYYY
Gender *
I am affiliated with Fencing New Zealand *
Please indicate which region you are affiliated with *
Your fencing club *
Your answer
Contact phone mumber/s *
Please include country code if not from NZ
Your answer
Which events do you wish to enter? *
U15 - Entry Fee is $55 for first weapon, $25 for each additional weapon. U17 - Entry Fee is $55 for first weapon, $25 for each additional weapon
Required
MEDICAL INFO
Medical conditions / allergies / injuries the organisers should be aware of *
Your answer
Medical insurance *
For overseas participants only. Please advise whether you have travel insurance and list name of your policy/ insurer.
Your answer
Emergency contact name(s) and phone number(s) *
Please make sure to include country and area codes if applicable.
Your answer
DISCLAIMER AND CONDITIONS OF ENTRY
for the participant
I wish to confirm my participation in the NZ U15 and U17 Championships. I acknowledge that I fence at my own risk and consent to emergency medical, hospital and ambulance services being obtained at my expense in the event of accident or sudden illness. As a competitor I agree to abide by the Fencing New Zealand Code of Conduct. *
DISCLAIMER AND CONDITIONS OF ENTRY
for the parent / legal guardian of U16 fencers
I consent to my daughter or son competing in the NZ Under 15 and Cadet Fencing Championships. In the event of illness or injury to my daughter or son, and where the organisers are unable to contact me or it is otherwise impractical to do so, I authorise the organisers to arrange the administration of first aid and/or referral for medical assessment and any treatment that may be necessary. Please type your full name to acknowledge acceptance. Put N/A if you are 16 year of age or older. *
Your answer
PAYMENT SECTION
Please note that entries are not complete until payment has been received.
Total amount due *
Competition entry for the NZ U15 is NZ$55 for the first weapon, NZ$25 for each additional weapon. Competition entry for the NZ U17 is NZ$55 for the first weapon, NZ$25 for each additional weapon. Please enter the total amount you are paying below (without a '$' sign).
Your answer
BANKING DETAILS
Please pay via Internet Banking Account name: Fencing Central; Account number: 02-0500-0025212-002 Please enter NZU1517 and your FIRST and LAST name in the reference fields. YOU ALSO FIND THIS PAYMENT INFORMATION ON WWW.FENCINGCENTRAL.ORG.NZ If you are unable to pay via internet banking please send us an email to make alternative arrangements - littleassociates@gmail.com

THANKS FOR ENTERING!

A copy of your responses will be emailed to the address you provided.
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