MASTERS OF RUGBY LEAGUE NEW ZEALAND INCORPORATED™
PO Box Zone 1743
www.mastersofrugbyleague.co.nz
Masters Rugby League is a game for a lifetime for semi-retired players and Officials
MRLNZI TOURNAMENT TEAM ENTRY FORM
Team Name:
Team Colour:
Contact Details:
Manager’s Name:
Email:
Home Phone:
Mobile:
Postal Address:
All confirmation fees must be paid to Masters of Rugby League NZ Inc
Fees for individual Player are set at $130.00 (Each). Official fees is set at $60.00 (Each)
Confirmation fees can be paid either by posting a cheque to:
PO Box 18136 Auckland
(Please manually write your Team’s name on the back of the cheque, Name of the contact person and
phone number/s).
OR
Online banking: ASB Blockhouse Bay, Account number 12 3049 0310740 00
(Please enter your Team’s name as a Reference when paying online banking example: PONIES and
Particulars: FEES)
Total number of Players:
Total Amount paid: $
Total number of Officials:
Total Amount paid: $
Total paid for the entire Team:
Date paid:
Payment Type i.e. CHEQUE or Internet Banking
Terms and Conditions of Entry
The Tournament Team Entry Form must accompany the Players and the Management/Supporter’s form.
Each Team must have 16 players to constitute a team. All Auckland Masters Teams must be registered with
Auckland Rugby League. Teams outside Auckland must be registered with their own Club, and District
League.
All forms must be signed by the Club Secretary, under seal before they are emailed back.
Players must have a Masters Rugby League ID card, no ID no play.
Online registration ONLY to: [email protected].
Travel and Medical Insurance is the sole responsibility of individual players. The Team must read the
disclaimer/waiver on this form
In the event of your Team’s withdrawal from any Masters Rugby League NZ Inc tournament after an entry
has been accepted, a 50 % of your registration fee will be made only if your written application for a refund is
received by the MRLNZI Chairman by 30th August 2017 before the tournament commences.
Entries will close on 1st of June 2017. Late entries will NOT be accepted.
Any changes to be made to any entry form/s after submission will incur a $20.00 penalty fee.
By signing this form, Teams and Individual Player/s have agreed to the rules and regulations of the Masters
of Rugby League NZ Inc.
The Masters of Rugby League NZ Inc reserves the right to refuse entry to any Player/s or Team/s.
Masters of Rugby League New Zealand Incorporated (Affiliated to New Zealand Rugby League) Copyright 2006™
MASTERS OF RUGBY LEAGUE NEW ZEALAND INCORPORATED™
PO Box Zone 1743
www.mastersofrugbyleague.co.nz
Masters Rugby League is a game for a lifetime for semi-retired players and Officials
WAIVER
Masters of Rugby League Tournament 2017 (“Tournament”)
Release and Indemnification Form
To: Masters of Rugby League Incorporated (“Tournament Organiser”)
The persons whose names appear in the team list set out in the attached Schedule (“Team List”) are
intending participants in the Tournament. Each person signing this form, in the space allocated for such
purpose in the space adjacent to their name in the Team List, severally acknowledges that:
1 Risk of injury: They are aware of the risk of injury, including severe and permanent injury, that they
expose themselves to as participants in the Tournament and notwithstanding this awareness,
they assume full risk of injury with prior knowledge of such risk;
2 Instructions: They must at all times follow the directions and instructions of the Tournament
Organiser, comply with the conditions of entry, and follow all rules and regulations applicable
at the Tournament;
3 Waiver and Indemnity: They enter into the Tournament entirely at their own risk and shall not look
to recover from the Tournament Organiser any damages of any sort whatsoever arising out of
their participation in the Tournament, and they shall fully indemnify the Tournament Organiser
for any loss suffered by it arising out any claim by them or any third parties.
4 Personal Possessions: They have sole responsibility for their personal possessions and sporting
equipment during the Tournament and its related activities.
5 Medical Treatment: They consent to receive medical treatment from any authorised
representative of the Tournament Organiser, which may be deemed necessary in the event of
injury, accident or illness during the Tournament.
6 Use of Images: They permit the Tournament Organiser to make use of all images of them, whether
digital or otherwise, that the Tournament Organiser acquires during the Tournament and
wishes to use for the Tournament Organisers own purposes.
Signed on behalf of the team listed above
Team Managers’ Name:
Date:
Printed signature:
Written Signature:
Date:
Updated: 22/01/2017
Masters of Rugby League New Zealand Incorporated (Affiliated to New Zealand Rugby League) Copyright 2013™