GBM2023 Entry Form

GBM2023 Entry Form

1 January 2023 to 7 January 2023
Club Name*
Branch, State*

Select your Division (if you have multiple crews, please submit separate entries)

Rows	Male	Female
Open Boat
Vet Boat
Super Vet Boat
Junior Boat
Spec Ski - Single
Spec Ski - Double
Ocean Ski
Junior Ski

Team Managers - Emergency Contact Persons

The Team Managers will be used as the team’s emergency contact and will need to be available during the event.
Person 1 - Name*

First NameLast Name
Person 1 - Mobile Phone*
Please enter a valid phone number.
Person 1 - Email *
example@example.com
Person 2 - Name*

First NameLast Name
Person 2 - Mobile Phone*
Please enter a valid phone number.
Person 2 - Email*
example@example.com
Your Club Bank Account Details

So we can direct deposit your prize money!
Account Name*
Bank Details*

BSBAccount Number
Competitor Details

Please fill shirt and vest sizing for each competitor for ordering purposes. We will contact your Team Manager to gather more info on your competitor/s in November.

Rows	Full Name	Shirt Size	Rash Vest
1
2
3
4
5
6
7
8
9

Please complete for each competitor.

Rows	Full Name	Financial	Proficient	Shirt Size	Rash Vest	Min 25 Patrol Competition Hours
1
2
3
4
5
6
7
8
9

Authorizing Club Officer
I First Name Last Name hereby declare that the above information regarding financial, proficiency and patrol hour compliance is true and correct.

Officer Position blanks.
Signature

Clear
Entry Fees and Additional Shirts

Select items that apply.

Early Bird Boat Crew Entry Fee

9 persons (paid prior to 30/9/22)

$700.00AUD Quantity
Item subtotal:$0.00AUD

Standard Boat Crew Entry Fee

9 persons (paid after 30/9/22)

$900.00AUD Quantity
Item subtotal:$0.00AUD

Early Bird Ski Paddler Entry Fee

per person (paid prior to 30/9/22)

$200.00AUD Quantity
Item subtotal:$0.00AUD

Standard Ski Paddler Entry Fee

per person (paid after 30/9/22)

$300.00AUD Quantity
Item subtotal:$0.00AUD

Extra Adult T-shirt

Orders required before 30/9/22

$25.00AUD

Size	Quantity
S
M
L
XL
2XL
3XL

Extra Kids T-shirt

Orders required before 30/9/22

$15.00AUD

Size	Quantity
4
6
8
10
12
14

Total

$0.00AUD

Payment
Please transfer the total amount payable to:

FSC BRANCH SLS – GEORGE BASS

BSB 802 124

Account Number 100 095 065

* Use your Club Name as a Reference

Email georgebassmarathon@gmail.com should you have any questions.
Should be Empty:

GBM2023 Entry Form

Team Managers - Emergency Contact Persons

Your Club Bank Account Details

Competitor Details

Authorizing Club Officer

Entry Fees and Additional Shirts

Payment