Nomination Form – Cartwright Cup T20 (wknd)
Saturday and Sunday – 8th & 9th April 2017
Team Name:
SURNAME
NO
___________________
Please print the information below. Note that email is the
primary method for pre-carnival correspondence.
Club
Contact
RECENT PLAYING DETAILS
(if applicable)
CLUB
GRADE YEAR
FIRST NAME
01
02
03
04
05
Address
P/C
06
07
08
Fax
Hm Ph
09
Mobile
Email
10
@
11
This application is lodged on behalf of the above mentioned
team. I accept the conditions as set out in the Constitution and
Competition By-laws of the Warehouse Cricket Association.
Signed
Total Cost = $240.00
(EFT PAYMENT TO WAREHOUSE CRICKET)
Suncorp - BSB: 484-799
Account No. 043622355
OR: Credit Card
Date
/
/2017
For Assistance
Ph:
Mail
3204-2020
PO BOX 488
KALLANGUR Q 4503
Email: [email protected]
Signed
Authority
/
Cardholder Name:
Credit Card Number:
-
Card Type:
□
Card Expiry Date:
Month
Visa
Receipt No:
□ MasterCard
Year 20____
-
/2017
Your Team Entry
Fee is all inclusive.
(All wicket fees,
cricket balls and
Umpire expenses.)
20 Teams will be
accepted on a first
paid, first in basis.