KIWITAG NELSON REGISTRATION FORM 2010/2011 MODULE
Subs: $180
TEAM NAME:
TEAM COLOURS:
ORGANISER:
*
EMAIL:
CONTACT PH NO:
*
-
Area Code
Phone Number
POSTAL ADDRESS:
TEAM MEMBER DETAILS:
1.Name:
E-mail
Phone Number
-
Area Code
Phone Number
2.Name:
E-mail
Phone Number
-
Area Code
Phone Number
3.Name:
E-mail
Phone Number
-
Area Code
Phone Number
4.Name:
E-mail
Phone Number
-
Area Code
Phone Number
5. Name:
E-mail
Phone Number
-
Area Code
Phone Number
6. Name:
E-mail
Phone Number
-
Area Code
Phone Number
7. Name:
E-mail
Phone Number
-
Area Code
Phone Number
8. Name:
E-mail
Phone Number
-
Area Code
Phone Number
9. Name:
E-mail
Phone Number
-
Area Code
Phone Number
10. Name:
E-mail
Phone Number
-
Area Code
Phone Number
11. Name:
E-mail
Phone Number
-
Area Code
Phone Number
12. Name:
E-mail
Phone Number
-
Area Code
Phone Number
Any relevant info we should know about:
Cheques payable to: Celebration Centre Nelson
GAME ON!
Submit Form
Should be Empty: