Warehouse Cricket Association - 2016/2017 Team Application
Team Name
Postal Address:
P. O.
Box 488 KALLANGUR 4503
Nomination Process: Can be emailed with Credit Card Authorization Form any time
or brought to Nomination Night as set down for Wednesday 24th August 2016
 Marchant Park (Chermside) & Peter Jorgensen’s Office, Crn Belmont and Manly Rds Tingalpa
Ground Information
Club
Secretary
Name
Complete this section if your club is nominating
a Ground as a venue of this season’s
competitions.
Street Address
Turf
Sub/Town
Synthetic
Enter Grade
Y/N
√
Saturday
Two Day Competition
(each Saturday)
Saturday (Social)
Synthetic = (Must be minimum of 2.8m wide)
Sunday T20
Ground Name:
Southside (ONLY)
Postcode
Sunday 50 Overs
Ground
Address:
Home Phone:
MOB:
Fax:
Email:
Competition:
Northside
Southside
Ground Phone:
@
UBD REF
Work Phone:
Note: New Grounds will only be used at the discretion
of the Executive Committee.
This application is lodged on behalf of the above mentioned Club. We
accept the conditions as set out in the Constitution and By-laws of the
Warehouse Cricket Association.
Club Secretary____________ Date
/
/2016
For Assistance
Laurence
3204-2020
Email:
[email protected]
Financial Information
Nomination Fee
$
Bond
$
Total Paid
$
Cash Rec:
Cheq Rec
Other:
$
$
$
Enter Player names on ”MYCRICKET”
FIRST
NAME
SURNAME
STREET
ADDRESS
SUBURB/TOWN
ADDRESS
POST
CODE
Date
Of
Birth
HOME
PHONE
No.
Grade last
Played
Summer/Winter
1
2
3
4
5
6
7
8
9
10
11
12
Player Registrations must be entered on ”MYCRICKET” (Directions will be available in Summer Invitation papers)
NEW TEAMS – CONTACT Peter Pfeffer on 3491-7770 or [email protected] for user name and password
Club
Name:
__
Unless listed on the attached sheets,
nominate all players likely to play for your club
this season
Grade Nominated
(1 Form per Team)
Warehouse Cricket Association - 2016-2017 Team Application
____________
Authority to Use Credit Card Details
Nomination of Team/S for Warehouse Cricket Competitions
Club Name:
THIS CREDIT CARD AUTHORITY PAYMENT RECORD CAN BE RETURNED BY
FAX OR POST ALONG WITH YOUR NOMINATION/S
Name of Person
Authorizing Payment:
Position in Club
Phone:
Mob:
Saturday Senior teams @ $525
Purpose of
Payment:
Saturday Social teams @ $325
NOMINATION OF
TEAM/S IN
2016-2017
Sunday Senior teams
@ $375
20/20
@ $275
Senior teams
Bonds @ $150
Summer Season
Total Payment
$
I authorize the Treasurer of Warehouse Cricket to debit my Credit Card as
detailed below to the amount of $__________
Signed
/
/2016
Cardholder Name:
Credit Card Number
Card Type:
Card Expiry Date:
□
Visa
Month
-
-
□ MasterCard
Year 20____
1. All Credit Card details will be destroyed by Warehouse Cricket Officials after processing of the bank
reconciliation which contains this payment. No other payment will be made on this authority.
Warehouse Cricket Suncorp Account – North Lakes
BSB = 484-799
A/C = 043622355
Email advice to Barry Peacock: [email protected]
when paid above