NIA Table Tennis Registration Form

Table Tennis Registration Form

Organised by Nepalese in Adelaide
Date- 13/08/2022, Saturday

Time- 9am - 8pm

Venue- Fresh chulo Nepalese resturant,

514 Cross Rd, Glandore SA 5037
Name of Player *

First Name Last Name
Gender

Male Female
Address *

Street Address

Street Address Line 2

Suburb State

Postal / Zip Code
Date of birth

Day Month Year
Date
Email Address *
Player Phone Number *

Area Phone Number
Name of Emergency Contact

First Name Last Name
Phone Number

Area Code Phone Number
15$ Registration fee

must be paid when submit this form
Bank Details

Nepalese in Adelaide

Bsb- 065124

Account number -10437941

commonwealth Bank

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