English Curling Association NATIONAL MIXED DOUBLES CHAMPIONSHIPS 2011 - 12 Fenton's Ice Rink, weekend 14th - 15th January 2012 Entry form to be returned to:
Phil Barton, 21 Inch Avenue, Aberdour, Fife, KY3 0TF or phil.barton@starleyhall.co.uk
Please enclose team entry fee of ÂŁ10 (payable to ECA)
CLOSING DATE FOR ENTRIES - 30th September 2011 We, the undersigned, wish to enter as a team in the above Championships and agree that: 1 2 3 4
If we fail to attend the event we shall be liable for any proportion of the ice fees which can be attributed to our absence. We are all Full members of a member club of the English Curling Association. (Note that this will need to be confirmed by your club secretary before you are able to play) We are all eligible to represent England as specified in Section 7.2 of the ECA Constitution If we are eliminated in any form of Playdown we shall not play for another team in the Championships unless requested to by the ECA Council.
The winning team will earn the right to represent England at the World Mixed Doubles Championships but they may choose to forfeit that right if they wish, in which case the ECA will ask another team to play. In the list of players below the first named should be the one to whom all correspondence is to be sent and whose name shall appear on the Championship draw.
NAME
ADDRESS
TELE. NUMBERS
CLUB
HOME
Signature
MOBILE WORK
........................................................
EMAIL HOME
Signature
MOBILE WORK
........................................................
OTHER EVENTS - the winning rink may be invited to represent the ECA in other international competitions. FOR OFFICIAL USE ONLY:
REC
NO