LCBA COMPETITIONS - ENTRY FORM

Event ____________________________Date of Event__________
Please send this form to the person taking entries as shown in the event details and make sure that any cheque is made payable as indicated
Name: ___________________________________________EBU No____________
Address ____________________________________________________________
__________________________________________________________________
______________________________________ Post Code:____________________
Tel No: _______________________E-mail: ______________________________
Partner: _________________________________________EBU No____________
Team Mate (if applicable): ___________________________EBU No____________
Team Mate (if applicable): ___________________________EBU No____________
Any special dietary requirements? _______________________________________
__________________________________________________________________

Total Amount Enclosed ________________________
If you want a receipt for your entry, please enclose an SAE.